Who Is Eligible For Medicaid
You may qualify for free or low-cost care through Medicaid based on income and family size.
In all states, Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states the program covers all low-income adults below a certain income level.
- First, find out if your state is expanding Medicaid and learn what that means for you.
- If your state is expanding Medicaid, use this chart to see what you may qualify for based on your income and family size.
Even if you were told you didn’t qualify for Medicaid in the past, you may qualify under the new rules. You can see if you qualify for Medicaid 2 ways:
- Visit your state’s Medicaid website. Use the drop-down menu at the top of this page to pick your state. You can apply right now and find out if you qualify. If you qualify, coverage can begin immediately.
- Fill out an application in the Health Insurance Marketplace. When you finish the application, we’ll tell you which programs you and your family qualify for. If it looks like anyone is eligible for Medicaid and/or CHIP, we’ll let the state agency know so you can enroll.
Majority Of People Covered By Medicaid And Similar Programs Are Children Older Adults Or Disabled
Medicaid provides health insurance coverage to more people than any other single program in the United States, with coverage for low-income children, adults, seniors, and those with disabilities.1 As of March 2017, there were 74 million Medicaid and Childrens Health Insurance Program enrollees, of which nearly 36 million were enrolled in CHIP or were children enrolled in Medicaid, according to the Center for Medicaid and CHIP Services.2
For a more detailed breakdown of people covered by Medicaid and other means-tested health insurance programs , we turned to the American Community Survey .3
As shown in the table below, children and youth represent nearly half of all people covered by means-tested public health insurance in the United States. Adults ages 65 and older, many of whom are low-income and participate in Medicaid to supplement Medicare, represent nearly 11 percent. Disabled and institutionalized adults account for another 14 percent, and women who have given birth in the past year represent just under 2 percent. These vulnerable groups account for more than seven in 10 participants in means-tested health insurance programs. Of those remaining, 12 percent work full time or part time. In short, Medicaid and CHIP participants are among the most vulnerable members of the U.S. population.
Table: The Majority of Publicly Insured Individuals Are Children, Older Adults, or Disabled.
How Much Does Medicare Cost At Age 65
The standard premium for Part B modestly increases year over year. Part A costs also can increase, including the annual deductible and other coinsurance. Known as hospital insurance, Part A doesnt require a monthly premium as long as you have paid Medicare taxes through employment for at least 10 years.
Part B, known as medical insurance, typically pays 80% of the covered cost while you pay the deductible and then 20%.
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Person Who Is Aged Blind And/or Disabled
Apply if you are aged , blind, or disabled and have limited income and resources. Apply if you are terminally ill and want to get hospice services. Apply if you are aged, blind, or disabled live in a nursing home and have limited income and resources. Apply if you are aged, blind, or disabled and need nursing home care, but can stay at home with special community care services. Apply if you are eligible for Medicare and have limited income and resources.
Spousal Impoverishment Prevention Coverage
This coverage applies to couples where one needs Nursing Care Services in a facility or at home.
The spouse receiving the nursing care services is allowed $3,000. The spouse who remains in the community is entitled to keep half of the couple’s countable assets, but not less than $27,480 and not more than $137,400 for calendar year 2022.
The spouse receiving the nursing care services may keep up to $65 of their monthly income and may deem income to bring the income of the spouse in community up to $2,550 per month and any dependent household members up to $726.
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Do I Automatically Get Medicare When I Turn 65
Some people automatically get Medicare at age 65, but those numbers have declined as the Medicare and Social Security ages have continued to drift apart.
Most people who automatically get Medicare at age 65 do so because they have been receiving Social Security benefits for at least four months before turning 65. Traditionally, Medicare premiums are deducted from your Social Security check. For the longest time, you could retire with full Social Security benefits at 65 and start on Medicare at the same time.
You are still automatically enrolled in Medicare Part A and Part B at 65 if youre drawing Social Security, but not as many people draw Social Security that early these days because of changes to the eligibility age for full Social Security benefits.
In 2000, the Social Security Amendments of 1983 began pushing back the standard age for full Social Security benefits. The progressive changes are nearing their conclusion: Beginning in 2022, the standard age for full benefits will be 67 for anyone born after 1960.
Besides the Medicare eligibility age of 65, what remains unchanged is that you can opt to begin drawing partial Social Security benefits as early as age 62. So, if you opt for accepting partial Social Security benefits before age 65, you are automatically enrolled in Medicare.
A smaller group of people also automatically get Medicare at age 65: people who receive Railroad Board benefits for at least four months before 65.
Taking Away Medicaid For Not Meeting Work Requirements Harms Older Americans
More than 8.5 million Americans age 50-64 get health coverage through Medicaid. Many of them became eligible due to the Affordable Care Acts expansion of Medicaid to more low-income adults, which helped drive a nearly 40 percent decline in uninsured rates for lower-income people age 50-64 between 2013 and 2016.
Now, the Trump Administration is allowing states to take away Medicaid coverage from people who dont document that they work a specified number of hours each month. Older adults face particular challenges in meeting work requirements, and the health consequences if they lose Medicaid coverage are likely to be especially severe.
The Administration is allowing states to impose work requirements on adult Medicaid enrollees other than those who are 65 or older, pregnant, or qualify for Medicaid because they receive disability benefits through the Supplemental Security Income program. In Arkansas, the first state to implement such a policy, over 18,000 Medicaid beneficiaries lost coverage in 2018 due to the new requirements. While a federal court halted Arkansas policy, the Administration is continuing to approve similar policies in other states. Most of these policies require enrollees to document that they work or engage in other work activities for at least 80 hours per month, unless they prove that they qualify for limited exemptions.
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Who Can Get Medicaid
- No matter your state, you may qualify for Medicaid based on your income, household size, disability, family status, and other factors. But if your state has expanded Medicaid coverage, you can qualify based on your income alone.
- Enter your household size and state. We’ll tell you who is eligible for Medicaid, if your state expanded and if you qualify for Medicaid based only on your income.
- If you think you have Medicaid eligibility, you can create an account and fill out a Marketplace application. If it looks like anyone in your household qualifies for Medicaid or CHIP, we’ll send your information to your state agency. They’ll contact you about enrollment. You can apply any time of year.
- If you don’t qualify for Medicaid, we’ll tell you if you qualify for financial help to buy a Marketplace health plan instead.
What Is The Medicaid Program
Good health is important to everyone. If you can’t afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy and stay healthy.
Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you instead, it sends payments directly to your health care providers. Depending on your state’s rules, you may also be asked to pay a small part of the cost for some medical services. In general, you should apply for Medicaid if you have limited income and resources. You must match one of the descriptions below:
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Reduced Coverage / Medicare Cost Sharing Or Premium Payment
Qualified Medicare BeneficiariesCovered group: individuals covered by MedicareIncome limits: Income cannot exceed 100% of the federal poverty level. For more information, view the Guidelines for Medicare Cost-Sharing Programs brochure.Age: Medicare beneficiaries of any ageQualifications: Individuals must be eligible for Medicare Part A hospital insurance.
Specified Low-Income Medicare BeneficiariesCovered group: individuals covered by MedicareIncome limits: Income cannot exceed 135% of the federal poverty level. For more information, view the Guidelines for Medicare Cost-Sharing Programs brochure.Age: Medicare beneficiaries of any ageQualifications: Individuals must have Medicare Part A
Qualified IndividualsCovered group: individuals covered by MedicareIncome limits: Income cannot exceed 135% of the federal poverty level. For more information, view the Guidelines for Medicare Cost-Sharing Programs brochure.Age: Medicare beneficiaries of any ageQualifications: Individuals must have Medicare Part A
Medicaid Adults 65 And Older & People With Disabilities
The Medicaid program provides comprehensive medical coverage to seniors and people with permanent disabilities. People receiving SSI benefits automatically receive Medicaid. Seniors and people with disabilities who are receiving Social Security Retirement or Disability benefits and have income/resources that exceed the SSI limits may be eligible for Medicaid under the rules described in this section.
Note: People with disabilities who are waiting for a decision on eligibility for SSI or Social Security Disability Insurance benefits may be eligible for Medicaid under the MAGI category.
Who Qualifies?
- People who have a severe physical and/or mental disability that has lasted or will last longer than one year or will result in death and prevents any substantial gainful employment.
- Must be a citizen or eligible immigrant. Eligible immigrants include refugees or persons granted asylum. Lawful Permanent Residents who entered the U.S. on/after 8/22/96 must be in status for at least 5 years. In addition, immigrants who were in lawful status in the U.S. before 8/22/96 and lived in RI at some time before 7/1/97 may be eligible for coverage.
Income and Resource Limits
How to Apply
You can apply on-line at healthyrhode.ri.gov. You can also request a paper application from a DHS office by calling: 1-855-697-4347 or by downloading the form from the EOHHS website at:
For more information on Medical Assistance see the EOHHS website.
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What If Im Turned Down By Medicaid
- You may be able to buy a private health plan through the Marketplace instead for the 2018 plan year in the fall. You may qualify for savings based on your income through a premium tax credit and savings on out-of-pocket costs.
- If you don’t qualify for either Marketplace or Medicaid savings, you still have options. Learn more here.
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Full Retirement Age By Year
Full retirement age is the age you begin to receive full Social Security benefits. If you start to draw your Social Security benefits before reaching your full retirement age, the payment you receive will be less.
An easy way to think about full benefits and retirement age is this,
- Social Security will reduce your payments if you choose to receive your benefit before full retirement age. The percentage of reduced amount is highest at age 62 and decreases until you reach full retirement age.
- If you choose to receive Social Security payments when you reach full retirement, you will get the total amount.
- Suppose you choose not to receive Social Security payments when you reach full retirement and delay your benefit. In that case, you can increase the amount of your payment by earning delayed retirement credits.
If youre not sure when you reach full retirement age, our table provides the years and months you need to know for full retirement.
Eligibility Through Family Relationship
An individual may qualify for Medicare before age 65 if a qualified person paid Medicare taxes for a certain period. The qualified person can be the person themselves or their parent or spouse.
Other health plans form part of Medicare, each of which has special rules and exceptions. These may denote where the plan is available and what it covers.
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How Do People Under Age 65 With Disabilities Qualify For Medicare
People under age 65 become eligible for Medicare if they have received SSDI payments for 24 months. Because people are required to wait five months before receiving disability benefits, SSDI recipients must wait a total of 29 months before their Medicare coverage begins. People under age 65 who are diagnosed with end-stage renal disease or amyotrophic lateral sclerosis automatically qualify for Medicare upon diagnosis without a waiting period. Of those who were receiving SSDI in 2014, 34% qualified due to mental disorders, 28% due to diseases of the musculoskeletal system and connective tissue, 4% due to injuries, 3% due to cancer, and 30% due to other diseases and conditions.
When Can I Enroll In Medicare
If you begin receiving retirement benefits from Social Security or the Railroad Retirement Board at least four months before you turn 65, youll most likely be automatically enrolled in Medicare Part A and Part B.
If you dont receive retirement benefits at least 4 months before your 65th birthday, you can manually enroll in Medicare Part A and Part B during your Initial Enrollment Period.
- Your Initial Enrollment Period begins three months before the month that you turn 65 years old. This enrollment period includes the month of your birthday and continues for three more months for a total of seven months.
- During this time, you may sign up for Medicare Part A and Part B. You may also enroll in a private Medicare plan during your IEP, such as a Medicare Advantage or Medicare Part D.
The best time to apply for a Medicare Supplement Insurance plan is during your 6-month Medigap Enrollment Period that begins the month you are both 65 years old and enrolled in Part B.
For questions about your Medicare eligibility, contact Medicare at 1-800-MEDICARE . You can also use the online Medicare Eligibility & Premium Calculator.
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What Are The Differences Between Medicare And Medicaid
Medicare is a federal health insurance program open to Americans age 65 and older and those under the age of 65 with specific disabilities. Medicaid, a combined state and federal program, is a state-specific health insurance program for low-income individuals with limited financial means, regardless of their age.
Medicare, generally speaking, offers the same benefits to all eligible participants. However, coverage is divided into Medicare Part A, Part B, and Part D. Medicare Part A is for hospice care, skilled nursing facility care, and in-patient hospital care. Medicare Part B is for out-patient care, durable medical equipment, and home health care. Part D is for prescription coverage. Not all persons will elect to have coverage in all three areas.
In addition, some persons choose to get their Medicare benefits via Medicare Advantage plans, also called Medicare Part C. These plans are available via private insurance companies and include the same benefits as Medicare Part A and Part B, as well as some additional ones, such as dental, vision, and hearing. Many Medicare Advantage plans also include Medicare Part D.
Medicaid is more comprehensive in its coverage, but the benefits are specific to the age group. Children have different eligibility requirements and receive different benefits from low-income adults and from elderly or disabled persons.
Helpful Resources
How Do Medicare Spending And Use Of Services Differ For Beneficiaries Under Age 65 With Disabilities And Older Beneficiaries
Medicare per capita spending
Traditional Medicare members under the age of 65 experience greater average total Medicare spending, primarily as a result of increasing Part D prescription drug costs. In 2014, the average Medicare per beneficiary under the age of 65 was $13,098 this was approximately a third higher than the average Medicare per beneficiary above the age of 65 . The gap narrows significantly to $9,281 for recipients under the age of 65 and $8,814 for those over the age of 65 when Part D prescription expenses are taken out of the equation. Compared to beneficiaries over 65, beneficiaries under 65 spend less per person on post-acute and hospice care but more per person on medications covered by Part D and inpatient and outpatient services.
Average Medicare Per Capita Spending by Type of Service for Beneficiaries Under 65 With Disabilities and Over 65, 2014
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