As people age, health care expenses often increase due to more frequent health challenges and needs for care. According to the Centers for Medicare & Medicaid Services, United States adults aged 65 and over spent an average of $22,356 on personal health expenses in 2020. This amount is almost 2.5 times higher than the $9,154 spent by younger adults. So, how can you manage these expenses?
While Medicare and Social Security benefits cover some costs, those with savings and long-term care insurance can also use these resources to pay for health expenses. However, if you find yourself needing more assistance, there are additional options.
Medicaid eligibility for those on Medicare
Individuals on Medicare, as well as any eligible person with very limited financial resources, may qualify for Medicaid to cover health costs that Medicare does not. In 2021, approximately 13 million people received health coverage under both Medicare and Medicaid, according to a KFF analysis.
- Health care expenses increase with age, with older adults spending significantly more than younger adults.
- Medicare and Social Security benefits cover some health care costs.
- Savings and long-term care insurance can help manage health expenses.
- Individuals with limited financial resources may qualify for Medicaid to cover additional costs.
Understanding your options and eligibility for both Medicare and Medicaid can significantly ease the financial burden of health care expenses as you age.
In the realm of healthcare, certain individuals are classified as “dual-eligible”, meaning they qualify for both Medicare and Medicaid benefits. This classification allows them to reap the advantages of partial or full Medicaid benefits alongside their Medicare coverage.
Key Requirements for Medicare and Medicaid
Understanding the eligibility criteria for Medicare and Medicaid is crucial. While anyone aged 65 or older can qualify for Medicare, qualifying for partial or full Medicaid benefits is contingent upon meeting specific income and asset requirements.
Income Limits for Partial Medicaid Benefits
The income thresholds for partial Medicaid benefits, including programs like the Medicare Savings Programs, are determined by the federal poverty level. Here are the income and asset limits for 2024 that qualify individuals for partial Medicaid benefits:
- Individual Monthly Income Limit: Ranges from $1,275 to $1,715
- Asset Limit: $9,430
It’s important to note that income limits are slightly more generous in states like Hawaii and Alaska. This is because inflation and cost of living is higher there.
Married Couple Income Limits
- Married Couple Monthly Income Limit: Ranges from $1,724 to $2,320
These thresholds are pivotal in determining eligibility for programs that can cover premiums for Medicare Parts A and B, as well as any co-pays or deductibles for services and items covered by Medicare.
By staying informed about these income and asset limits, individuals and couples can better navigate the complexities of qualifying for necessary healthcare benefits. Understanding these nuances ensures that those who are dual-eligible can make the most of their available resources and receive the comprehensive care they deserve.
Understanding the financial limits and benefits of Medicaid is crucial, especially if you’re navigating the complexities of qualifying for this essential program. Let’s break down the key components you need to know.
Asset Limit for Medicaid
The asset limit stands at $14,130. This figure is vital when calculating eligibility for partial benefits. According to Alice Burns, the Associate Director of the Program on Medicaid & Uninsured at KFF, income includes monthly Social Security payments. But what exactly counts as assets? Let’s delve into that.
What Counts as Assets?
Your assets include:
- Money in a checking, savings, or retirement account
- Stocks and bonds
However, states typically exempt other types of assets, such as:
- Your home
- One car
- A burial plot
- Up to $1,500 for burial expenses
- Furniture and other household items
Income Limits for Full Medicaid
Income limits for full Medicaid benefits can vary significantly both across and within states. Most commonly, these limits are based on Supplemental Social Security Income (SSI), which limits individuals to $943 per month in income and up to $2,000 in savings and other financial assets.
Services Covered by Medicaid
As noted by Alice Burns, the services covered by Medicaid also vary by state. Some of the services you might expect include:
- Long-term nursing home care
- Home health care services to assist with daily living activities
- Dental and vision care
- And more
Being informed about these limits and the range of services can help you better navigate the process of qualifying for Medicaid, ensuring you or your loved ones get the necessary care and support.
If you’re uncertain about whether you qualify for Medicaid, consider seeking professional assistance. Diane Omdahl, author of Medicare for You and cofounder of the Medicare advisory firm 65 Incorporated, advises, “I always recommend contacting an attorney who specializes in geriatrics and the state Medicaid rules.”
Non-Financial Eligibility Requirements
Beyond meeting the financial criteria, Medicaid beneficiaries must also fulfill certain non-financial requirements. These include:
- Being a resident of the state where they receive Medicaid
- Being a U.S. citizen or a lawful permanent resident
To understand the specific Medicaid eligibility requirements in your state, it’s essential to consult with your state Medicaid agency.
Types of Plans for Dual-Eligible Individuals
For those who are dual-eligible, meaning they qualify for both Medicaid and Medicare, there are multiple plan options available:
- Traditional Medicare: This can be paired with Medicaid to provide comprehensive coverage.
- Medicare Advantage Plans: An increasing number of people are opting for Medicare Advantage plans that are specifically designed for dual-eligible individuals.
Understanding and navigating the various plan options can be complex, but with the right guidance and support, you can make informed decisions that best meet your healthcare needs.
