Unitedhealthcare Dual Complete Plans
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711, or use your preferred relay service for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
Supplemental Security Income Overview
WHAT IS SSI?
SSI stands for Supplemental Security Income. Social Security administers this program. We pay monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. Blind or disabled children may also get SSI.
HOW IS SSI DIFFERENT FROM SOCIAL SECURITY BENEFITS?
Many people who are eligible for SSI may also be entitled to Social Security benefits. In fact, the application for SSI is also an application for Social Security benefits. However, SSI and Social Security are different in many ways.
HOW IS SSI LIKE SOCIAL SECURITY BENEFITS?
Both programs pay monthly benefits.
The medical standards for disability are generally the same in both programs for individuals age 18 or older. For children from birth to the attainment of age 18 there is a separate definition of disability under SSI. The medical standard is based on the severity of your disability financial need is not considered at this step in the eligibility process.
SSA administers both programs.
Dental Benefits For Adults In Medicaid
States have flexibility to determine what dental benefits are provided to adult Medicaid enrollees. While most states provide at least emergency dental services for adults, less than half of the states currently provide comprehensive dental care. There are no minimum requirements for adult dental coverage.
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How To Apply For Medicaid
Because Medicaid is administered through the state and states determine eligibility, you will need to visit your state’s Medicaid office or website to apply. When applying you will need proof of income, residency, age, citizenship and/or immigration status for every member of your household.
Contact your state Medicaid office . Getting approved for Medicaid can take time, so start the application process as soon as there is a clear need. Most offices allow you to apply or at least start your request online. You may need to go into one of their offices for an interview as part of the application process. Have all your needed verification documents ready.
Medicaids Eligibility factors include income, residency, age, citizenship, immigration status, household composition, and pregnancy.
The exact verification documents you will need will vary based on what state you are in. However, be prepared to have any proof of income, proof of residency, your social security card, and immigration status confirmation documents on hand . Generally, household composition and pregnancy status do not require formal verification.
Children’s Oral Health Initiative
The Centers for Medicare & Medicaid Services is committed to improving access to dental and oral health services for children enrolled in Medicaid and CHIP. We have been making considerable progress in our efforts to ensure that low-income children have access to oral health care. From 2007 to 2011, almost half of all states achieved at least a ten percentage point increase in the proportion of children enrolled in Medicaid and CHIP that received a preventive dental service during the reporting year. Yet, tooth decay remains one of the most common chronic childhood diseases.
To support continued progress, in 2010 CMS launched the Children’s Oral Health Initiative and set goals for improvement by FFY 2015. To achieve those goals, we have adopted a national oral health strategy through which we are working diligently with states and federal partners, as well as the dental provider community, children’s advocates and other stakeholders to improve children’s access to dental care.
To support state Medicaid and CHIP programs in achieving their improvement goals, we developed Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children and Adolescents. It provides an overview of the children’s dental benefit in Medicaid, support for evidence-based policies at the state level, and details of successful strategies with state examples.
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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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Health Coverage For People With Disabilities
If you have a disability, you have three options for health coverage through the government.
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Medicaid provides free or low-cost medical benefits to people with disabilities. Learn about eligibility and how to apply.
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Medicare provides medical health insurance to people under 65 with certain disabilities and any age with end-stage renal disease . Learn about eligibility, how to apply and coverage.
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Affordable Care Act Marketplace offers options to people who have a disability, dont qualify for disability benefits, and need health coverage. Learn about the .
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What Is Temporary Assistance For Needy Families
Temporary Assistance for Needy Families is a federal program that provides temporary financial assistance to low-income families with children. TANF benefits can be used for a variety of needs, such as rent, food, utilities, and child care.
To be eligible for TANF, you must meet certain income and asset requirements. You can apply for TANF benefits through your local TANF office or online at www.tanf.gov.
What is the Earned Income Tax ?
The Earned Income Tax Credit is a federal tax credit for low- and moderate-income workers. The EITC can reduce your tax bill or increase your refund, and you do not have to pay taxes on the credit.
To be eligible for the EITC, you must have earned income from employment or self-employment. You can apply for the EITC when you file your taxes. For more information, visit www.eitc.irs.gov.
Medicare For Ssi Recipients
Do you get Medicare coverage if you were approved for SSI? Claimants who are approved for SSI only typically receive Medicaid coverage in most states. And like SSI, Medicaid is subject to income and asset limitations. Medicaid is a needs-based, state- and county-administered program that provides for a number of doctor visits and prescriptions each month, as well as nursing home care under certain conditions.Can you ever get Medicare if you get SSI? Medicare coverage for SSI recipients does not occur until an individual reaches the age of 65 if they were only entitled to receive monthly SSI disability benefits. At the age of 65, these individuals are able to file an uninsured Medicare claim, which saves the state they reside in the cost of Medicaid coverage. Basically, the state pays the medical premiums for an uninsured individual to be in Medicare so that their costs in health coverage provided through Medicaid goes down.
For people with limited income and assets, Medicare offers Extra Help for prescription drug costs. This Extra Help covers the costs of a Medicare prescription drug plan including monthly premiums and prescription co-pays. The application is online at www.socialsecurity.gov/prescriptionhelp. For more information, see Nolos article on the Extra Help subsidy.
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How Can I Get Ssi Medicaid
To be eligible for SSI Medicaid, you must meet certain income and resource requirements. You can apply for SSI Medicaid through your local Medicaid office or online at www.medicaid.gov.
If you have questions about SSI Medicaid, you can contact your local Medicaid office or the Social Security Administration at 1-800-772-1213.
Eligibility Requirements For Medicaid And Ssi
Supplemental Security Income has the same eligibility requirements for all Americans, whereas Medicaid eligibility rules are different depending on the state in which one resides. Despite the state variances, the criteria for acceptance often overlap.
Income
For an applicant who is single to be eligible for SSI, their income in 2022 must be less than $841 per month. Married couples must have a combined income of less than $1,261 per month.
Medicaid eligibility criteria is very similar to SSI, but the important thing to know is that it can vary widely depending which state one lives in. Usually, Medicaid is for people who make less than $2,523 per month, but that figure might be different in your state.
Obviously, someone who earns $841 or less and qualifies for SSI would also be financially eligible for Medicaid.
Assets
While the income limits are usually three times higher for Medicaid than SSI, the asset limits are often the same: $2,000 for a single individual and $3,000 for a couple.
Countable assets for eligibility purposes often do not include ones home or vehicle, but will include money in bank accounts. For more on which assets are countable and which are not, .
Physical / Functional Criteria
There are also some physical or functional requirements for SSI. Recipients must meet one of these requirements: Be 65 or older Be partially or fully blind Have a medical condition that impairs the ability to work
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What If Iwas Approved For Ssi But Denied Medicaid
If you receive SSI but were denied Medicaid benefits in a 209state or any state for that matter, you should appeal the decision to yourstates Medicaid agency. Your state has to follow certain federal Medicaidrules in notifying you of the denial and holding a hearing. To learn more, readNolos article on appealinga Medicaid denial.
You could be eligible for up to $3,148 per month in SSDI benefits
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Who Is Eligible For Medicare Medicaid
Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income.
Do you lose your health insurance when you go on disability?
Short and long term disability benefits do not cover the cost of health insurance premiums. Rather, STD and LTD policies pay a percentage of your income while you are unable to work.
Is Medicare free for disabled?
Answer: You are eligible for Medicare two years after your entitlement date for Social Security disability insurance . Medicare isnt free for most disability recipients though. There are premiums, deductibles, and copays for most parts of Medicare, and the costs go up every year.
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How Are These Categories Different From Normal Medicaid Eligibility
Each of these eligibility programs are designed to meet the unique needs of people who are aging, disabled or have excessive medical bills. In almost all cases, they do not otherwise qualify for Medicaid. However, once enrolled, all of these recipients get the same full benefit Medicaid coverage as everyone else.
Dental Benefits For Children In Medicaid
Medicaid covers dental services for all child enrollees as part of a comprehensive set of benefits, referred to as the Early and Periodic Screening, Diagnostic and Treatment benefit. Though oral screening may be part of a physical exam, it does not substitute for a dental examination performed by a dentist. A referral to a dentist is required for every child in accordance with the periodicity schedule set by a state.
Dental services for children must minimally include:
- Relief of pain and infections
- Restoration of teeth
- Maintenance of dental health
The EPSDT benefit requires that all services must be provided if determined medically necessary. States determine medical necessity. If a condition requiring treatment is discovered during a screening, the state must provide the necessary services to treat that condition, whether or not such services are included in a state’s Medicaid plan.
Each state is required to develop a dental periodicity schedule in consultation with recognized dental organizations involved in child health care. Dental services may not be limited to emergency services for children entitled to EPSDT.
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How Ssi And Medicaid Are Linked
Supplemental Security Income is a cash benefit provided through the federal governments Social Security Administration to recipients who meet these criteria:
SSI recipients are low-income, meaning they earn less than a certain amount every month and have assets whose total value falls under a specified limit SSI recipients are aged, blind, or disabled
In this way, SSI is quite similar to Medicaid, which also has income and asset limits. And for older individuals who need Medicaid Long Term Care benefits, like nursing home coverage or care services in their own home or assisted living community, there is a functional requirement as well, meaning that someone must demonstrate that they need the Medicaid Long Term Care benefits when they apply.
Because the criteria are so close, in fact, someone who is eligible for one program is often eligible for another. In most states, SSI recipients are automatically accepted into Medicaid, and in some of those states they dont even need to apply for Medicaid because the application is the same.
There are additional steps to receive nursing home Medicaid or HCBS waivers, described below, but the application process should move faster.
I Have Ssdi Does That Qualify Me What Is The Difference Between Ssi And Ssdi
Social Security Disability Income is not the same as Supplemental Security Income . SSDI is based on an individuals earnings record. Whereas, Supplemental Security Income serves the needy and eligibility is based on having limited income and resources. It is possible for an individual to qualify for both SSDI and SSI benefits but you must apply for SSI with the Social Security Administration to retain Medicaid eligibility if there are budget cuts to these programs. Having SSDI will not maintain your eligibility.
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Effective Date Of Coverage
Once an individual is determined eligible for Medicaid, coverage is effective either on the date of application or the first day of the month of application. Benefits also may be covered retroactively for up to three months prior to the month of application, if the individual would have been eligible during that period had he or she applied. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.
Special Home And Community
The Special Home and Community-Based Services Waiver Group eligibility pathway allows states to extend Medicaid eligibility to individuals receiving HCBS under a waiver program87 who require the level of care provided by a nursing facility or other medical institution.88 This eligibility pathway is sometimes referred to as the 217 Group in reference to the specific regulatory section for this group, 42 C.F.R. Section 435.217. States use the highest income and resource standard of a separate eligibility group covered by the state plan under which an individual would otherwise qualify if institutionalized. For example, states that offer the Special Income Level pathway described above can extend eligibility to waiver program participants with income up to 300% of the SSI FBR. States must use the income- and resource-counting methodologies used to determine eligibility for this same eligibility group. States may also apply Section 1902s more liberal income-counting rules to this group.
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People With Disabilities Are At Risk Of Losing Medicaid Coverage Without The Aca Expansion
On November 10, 2020, the Supreme Court will hear oral argument in a case that could invalidate the entire Affordable Care Act , including the Medicaid expansion. Without the ACA, most people who gained coverage through the Medicaid expansion would likely become uninsured, and states would lose access to the enhanced federal matching funds to finance this coverage. Many people who qualify for the ACA Medicaid expansion have a disability, despite that they do not meet the strict medical standard to qualify for federal Supplemental Security Income cash assistance benefits and therefore do not qualify for Medicaid on that basis. This data note presents the latest state-level data about nonelderly Medicaid adults who have disabilities but do not quality for SSI and considers the implications for their continued coverage if the ACA expansion is invalidated by the Court. Key findings include the following:
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I Am 54 And Living With A Permanent Disability And For The Past 12 Months I Have Been Receiving Social Security Disability Insurance Payments But I Do Not Have Health Insurance I Am Required To Wait Another 12 Months Before I Can Go On Medicare Due To The Two
Yes, you are eligible to purchase coverage through the Marketplace, and if your income is between at least 100% of poverty you will qualify for premium tax credits to help make Marketplace coverage more affordable. If you live in a state that has expanded its Medicaid program to cover adults under age 65 with incomes up to 138% of poverty , you might also be eligible for this coverage, depending on your income.
If you apply for and receive Marketplace coverage and subsidies, keep in mind that your eligibility for Marketplace subsidies will end when your Medicare Part A and Part B coverage automatically begins after the two-year waiting period. At that point, you will have to pay the full price for your Marketplace coverage, but you could instead drop your Marketplace coverage and enroll in Medicare Part A, Part B and Part D. If you keep both Medicare and Marketplace coverage, Medicare will be the primary payer.
Once your Medicare coverage begins, depending on your income, you may qualify for Medicaid in addition to Medicare or for extra help with premiums and cost sharing for your Part D prescription drug benefits. A good place to turn for information about these programs and whether you might qualify is your local Social Security Administration office or the State Health Insurance Assistance Program in your state. Medicare provides links and phone numbers for these and other organizations at the following website: .
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