Can I qualify for Medicaid if my income is higher than the limit?
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If you need Medicaid coverage, and your income is above the Medicaid income guidelines in your state, there are several ways you may still qualify for Medicaid coverage.
- If you are above the limit but need the help, you should still apply. Depending on the Medicaid program and the rules in your state, certain income and assets may not be counted.
- If you have high medical expenses, you may qualify for a Medicaid spend-down or medically needy program. The spend-down program is sometimes also referred to as Medicaid's Excess Income Program. Not all states have Medicaid Spend-Down programs.
- The spend down is meant for people who have income slightly higher than would normally qualify them for Medicaid coverage, but who have medical expenses that significantly reduce their usable income. Some states require you to submit receipts or bills to Medicaid to show your medical expenses. In others, you may be able to pay a monthly premium directly to Medicaid for the amount that your income is over your state’s Medicaid spend-down level. These spend-down income limits are generally lower than the Medicaid income limits for people who do not spend down.
- Your spend-down amount will be the difference between your income and the Medicaid eligibility limit over a certain period of time. Your state will determine the length of the time period—it could be from one to six months.
- Your state may require you to spend-down for multiple periods in order to qualify for Medicaid inpatient hospital coverage.
- Each period that you have enough medical expenses to meet your spend-down amount, you will have Medicaid coverage. If you do not meet your spend-down amount for a certain period of time, you will not have Medicaid coverage for that time, but you could still get Medicaid coverage later if you were to meet your Medicaid spend-down amount during another period of the year.
- States with spend-down programs may allow you to use excess medical expenses to qualify for Medicaid nursing facility coverage. Some states may also allow you to spend down to qualify for home and community-based waiver services.
- Note: If your state does not have a spend-down program, it should have higher Medicaid income guidelines for people who need nursing home care than for those who do not.
- Medicare will still pay first for most of your medical services. When you qualify for Medicaid, it will pay second for Medicare-covered services by paying for your remaining costs, like the Medicare coinsurances, copayments and deductibles. Medicaid will also pay for some medical services that are not covered by Medicare, such as routine dental care.
- You will automatically qualify for Extra Help, the federal program that helps pay for most of your Medicare drug coverage (Part D), the first month that you spend down to Medicaid until the end of the calendar year (even if you do not meet your spend-down amount every period).
- In some states, trusts are a way for you to qualify for Medicaid if you are over the income or asset eligibility guidelines. These trusts, such as Miller Trusts and Supplemental Needs Trusts or Special Needs Trusts, allow people who have higher income or assets than the Medicaid eligibility guidelines to place a portion of their income or assets into the trust. Rules about how these trusts work vary greatly by state. If you are interested in participating in a trust, you should contact an elder law attorney.
- Some states offer the Medicaid Buy-In program, which allows people who are under age 65 and have a disability to work (as little as one hour a month) and still get Medicaid benefits.
- The program is designed to help people with disabilities who would otherwise not be eligible for Medicaid health coverage because their income or assets are too high. If you qualify, you may be able to receive Medicaid by paying a premium to buy in to the program. Financial eligibility guidelines vary by state. Check with your local office for eligibility information.
- Note: If you decide to work and are receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), check with your local Social Security office to see how much earned income you are allowed to have without losing those benefits.
- Medicare will still pay first for most of your medical services. Medicaid will pay second for Medicare-covered services by paying for your remaining costs, like the Medicare coinsurances, copayments and deductibles. Medicaid will also pay for medical services that Medicaid covers but that are not covered by Medicare.