Have a Higher Income Than Medicaid Limits – You Have More Options Than You Think

As seniors grow older, they may find it difficult to pay for rising health care costs. This is at a time when, for most, their income is reduced. Many see the Medicaid income requirements listed for their state and are immediately deterred from applying.

The fact is, qualifying for Medicaid is not based upon your income alone. Income is but one of many considerations your state will take in determining your eligibility for Medicaid. You will not know if you qualify for one of these programs until you at least take the time to apply. Since there is no limited enrollment period, you can apply at any time to see if you still qualify despite your income.

Look Into Trusts to Help You Qualify

One option for someone who has an income that disqualifies them from Medicaid would be a trust. A trust works by allowing individuals with assets and income greater than the limit set by Medicaid to allocate some of their income to enter into a trust. The trust then gives the recipient and their spouse, if applicable, a small monthly income allowance.

If the recipient dies, the trust will be used to pay Medicaid back for healthcare costs. There are a number of these trusts out there for you. Miller Trusts, Supplemental Needs Trusts and Special Needs Trusts are a few examples. Since the rules for trusts vary from state-to-state, it is recommended that you consult an attorney if pursuing this option.

Medicaid Spend-Down Programs 

A Medicaid Spend-Down program is designed for individuals who might be over the income requirements for Medicaid. However, they have high healthcare costs and are therefore deemed “medically needy.” If you are paying enough in healthcare costs to make your income fall below the income limit for Medicaid, you might qualify for the Medicaid Spend-Down program.

This program allows you to subtract your medical costs from your income, and in doing so, can make you eligible for Medicaid if the end figure is under the Medicaid income limits. There might be greater or fewer restrictions on this program depending on your state’s requirements, but in general, as an individual, you cannot have assets over $14,850 or as a couple over $21,750 to qualify.

Dual Eligibility

On reaching the age of 65, seniors are eligible for Medicare. If their income is low enough to qualify for Medicaid also, then they are “dual eligible.” Medicaid should pick up the costs of what Medicare does not pay for. However, since rules for Medicaid differ from state to state, check with your local social services office. They can tell you what benefits you may be entitled to.

Brief Review of Medicare

Briefly, there are four parts to the Medicare program. Specifically Parts A,B,C and D.

• Part A—no cost for most. Covers hospital costs, skilled nursing, Hospice and some home care.
• Part B—Has a premium. Covers visits to the Dr., lab work, preventive visits, surgery, some medical equipment and supplies.
• Part C—Costs vary. Also called Medicare Advantage. Provided by private insurance that have contracts with Medicare.
• Part D—Covers prescription medication.

What you pay for Medicare will be determined by the amount of coverage you need. Most seniors, even those with a low income, purchase private insurance to fill in the gap of what Medicare does not pay.

Private Health Insurance

You may have private health insurance through your employer. If so, when you retire, this may or may not be part of your pension plan. In addition, private health insurance is sold to seniors under the name Medigap. Medigap insurance will help you to pay the deductible for Medicare. In addition, it will cover co-payments as well. Once Medicare pays its 80%, then your Medigap insurance will cover the rest.

More About Medigap

Do not confuse Medigap with Medicare Advantage. Medicare Advantage actually supplies benefits, while Medigap supplements the Medicare benefits you have. Additionally, Medigap will not cover dental, vision or hearing care. Also, you can only purchase Medigap coverage if you have Parts A and B of Medicare.

Options for Veterans

Military veterans have more options for health care. If you have served more than two years in the military, you may qualify for health care benefits. As a senior veteran, you qualify for both Medicare and health care from the VA. You can apply for the TRICARE program which is similar to a Medigap plan. It will pay for certain health care costs that are not covered by Parts A and B of Medicare.

Assisted Living

Assisted living costs can be overwhelming. Unfortunately, Medicare does not cover the costs related to this type of care. However, most of the states offer programs to assist or cover these costs for low-income seniors. Check with your local social services office to point you in the right direction.

Partnership for Long Term Care

There is a program known as the Partnership for Long Term Care. It is currently available in 43 states. It combines private insurance with Medicaid coverage. This program may allow the senior to keep some of their assets while still receiving coverage.

PACE Program

PACE stands for Program of All Inclusive Care for the Elderly. It combines Medicare and Medicaid for senior. This program allows to senior to remain in his home while receiving long-term nursing care. PACE is currently available in 28 states.

Medicaid Comprehensive Insurance

Millions of Americans, the majority of whom are in working families, have access to Medicaid’s comprehensive healthcare and financial security. Its enrollees get access to care at rates equivalent to private insurance, notwithstanding their modest income.

It supports expensive long-term care for millions of elderly people and individuals with disabilities of all ages, in nursing facilities and the community, in addition to acute medical care.

It supports the private insurance market by serving as a high-risk pool to cover many uninsured people who have turned away from private insurance; it is a good option for those that can’t receive employment-based health insurance system due to low income, bad health conditions, or a handicap.

How to Get Low-Cost Healthcare

In addition to providing long-term therapies and medical help not covered by Medicare, it supports Medicare by helping low-income Medicare beneficiaries pay for premiums and cost-sharing. But this leads to the question: How can I get low-cost health insurance?

Medicaid is a social welfare program. It offers low-income individuals government-sponsored health insurance. This insurance is comprehensive since it provides a wide range of services. For those who qualify, Medicaid often provides free health insurance. A few states impose minor premiums for those with higher income levels who are eligible for Medicaid.

Government Subsidies & Health Insurance

Usually, your employer or the government provides subsidies. If you receive support, you won’t be responsible for covering the entire cost of the insurance. It’s a terrific option to get affordable health insurance if you are eligible for subsidies.

Most people are eligible for subsidies from the government through Medicare or Medicaid or from an employer.

Medicaid Plans with Cut Benefits

The insurance you’re purchasing in the situation described in the subheading does not offers much coverage. It is not comprehensive health insurance, in other words. Less thorough coverage may appear enticing initially, but it’s not always sufficient if you have an important medical claim.

What is the Affordable Care Act?

The comprehensive healthcare reform bill and its revisions are often called the “Affordable Care Act” (ACA). The law targets preventive care, health care expenses, and health insurance coverage. For those who qualify, the Affordable Care Act (ACA) aims to reform the health insurance market and reduce the price of health insurance.

For the benefit of people and families with lower incomes, the law contains premium tax credits and cost-sharing reductions.

A list of preventative services, such as checkups, patient counseling, vaccines, and various health tests, must be covered by most insurance plans, including those offered via the Health Insurance Marketplace, at no extra cost to policyholders.

Specific “essential health benefits,” such as emergency services, family planning, maternity care, hospitalization, prescription drugs, mental health services, and pediatric care, must be covered by every health insurance plan that complies with the Affordable Care Act.

How Can the Affordable Care Act Help Me?

The Affordable Care Act (ACA) can help the average American in a number of different ways. There are many things that this act can help with but it’s three key goals are as follows:

• Make more people eligible for affordable health insurance. The law offers subsidies to consumers that can reduce expenses for families whose incomes are below the federal poverty line (FPL).
• The Medicaid program should cover all people with income; however, not all states have done so, and this where the ACA picks up the slack.
• Encourage cutting-edge medical care delivery strategies intended to reduce overall health care expenditures.

How Much Will My Insurance Cost With the ACA?

There are many things to consider when trying to understand how much the Affordable Care Act will cost you. The cost of health insurance in the marketplace established by the Affordable Care Act (ACA) varies depending on the following:

• The insurance provider
• Your location
• The plan you select
• The number of people insured
• Your age
• Your smoking status
• The size of your household
• Your family
• Your income.

As of 2022, the average monthly price for a Bronze ACA health insurance plan is $928. The average monthly price rises to $1,217 and $1,336 for Silver and Gold plans. These averages do not account for premium tax credits and subsidies, which, depending on household income, can lower the cost of an ACA plan.