Dear Marci,
I have Medicare and recently learned that I might qualify for Medicaid based on my income. What determines whether someone is eligible for Medicaid, and what kind of Medicaid programs are available to people with Medicare?
– Kathleen (Florence, AL)
Dear Kathleen,
If you are eligible for Medicare and have limited income, you may qualify for a Medicaid program in your state. Whether you qualify will usually depends on:
- Your earned and unearned income, including wages and Social Security payments
- Your assets, including checking accounts, stocks, and some property
- Your nursing care and long-term care needs
Medicaid is government health insurance for people with limited resources. There are federal requirements that apply in all states, but each state Medicaid program can vary within those limits. The Medicaid programs available to Medicare beneficiaries in all states include Medicaid for people who are Aged, Blind or Disabled (ABD) plus special programs for people who need a certain amount of long-term care services and support, in either a nursing facility or in a community based setting.
Keep in mind that, in all of these cases, when you have both Medicare and Medicaid, Medicare will pay first and Medicaid will pay second for services that are covered by both programs. You may be eligible for:
- Aged, blind, and disabled (ABD) Medicaid: People over age 65, who are blind or who have permanent disabilities are eligible for this program if their income and assets are below limits set by the state. These income limits may be lower than those that apply to other populations. ABD Medicaid covers a broad range of health services, including doctors’ visits, hospital care, and medical equipment. Remember that Medicare pays first for Medicare covered services – Medicaid may pay your Medicare cost-sharing (or protect you from being billed for cost sharing, even if it does not make a separate payment for services that Medicare covers) and may pay primary for services Medicaid covers that Medicare does not, for example dental services (in some states.)
- Institutional Medicaid: If you live in a nursing home and require a certain level of care, you may qualify for institutional Medicaid. Income and asset limits for institutional Medicaid are higher than for ABD Medicaid—and there are specific rules to account for situations where one spouse is in an institution and the other lives in the community. Institutional Medicaid covers room and board, nursing care, personal care, and therapy services.
- Medicaid home and community-based service (HCBS) waiver programs: If you have significant long term care needs and live at home or in certain community based settings (not a nursing home or skilled nursing facility), you may be eligible for Medicaid through a waiver program. Home and Community Based Service waivers allow states to use the higher institutional Medicaid income and asset limits and to provide additional services to people who need an institutional level of care but who choose to receive that care in their home or in another community-based setting. Services may include personal care, homemaker services, case management, adult day care, skilled nursing care, or therapy services.
Contact your local Medicaid office to learn more about Medicaid programs in your state.
Hope this answers your question!