i have medicaid when i apply for medicare in ny

by Dewitt Douglas Published 3 years ago Updated 2 years ago

Can you have Medicaid and Medicare in NY?

IB-Dual allows members who are Medicare eligible to remain in their Mainstream Medicaid Managed Care health plan. You will receive both your Medicaid services and Medicare benefits through your current health plan as a dual-eligible beneficary.

Can you have Medicaid and Medicare?

Medicaid is a state and federal program that provides health coverage if you have a very low income. If you are eligible for both Medicare and Medicaid (dually eligible), you can have both. They will work together to provide you with health coverage and lower your costs.

How do I qualify for dual Medicare and Medicaid?

Persons who are eligible for both Medicare and Medicaid are called “dual eligibles”, or sometimes, Medicare-Medicaid enrollees. To be considered dually eligible, persons must be enrolled in Medicare Part A (hospital insurance), and / or Medicare Part B (medical insurance).Feb 11, 2022

Who is eligible for Medicare NY?

You can qualify for Medicare if you are age 65 or older and/or if you have certain disabilities or End-Stage Renal Disease (ERSD).

What happens to my Medicaid when I turn 65?

To be clear, Medicaid remains available after age 65 and many older adults rely on it — for example, the majority of nursing home residents in the United States have Medicaid coverage in addition to their Medicare coverage. But once you turn 65, eligibility for Medicaid is based on both income and assets.Oct 14, 2021

How do I enroll in Medicaid?

There are two ways to apply for Medicaid:

Contact your state Medicaid agency. You must be a resident of the state where you are applying for benefits.
Fill out an application through the Health Insurance Marketplace.

Jun 14, 2021

When the patient is covered by both Medicare and Medicaid what would be the order of reimbursement?

gov . Medicare pays first, and Medicaid pays second . If the employer has 20 or more employees, then the group health plan pays first, and Medicare pays second .

Who is eligible for Medicaid?

Medicaid beneficiaries generally must be residents of the state in which they are receiving Medicaid. They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. In addition, some eligibility groups are limited by age, or by pregnancy or parenting status.

Is UnitedHealthcare dual complete Medicare and Medicaid?

UnitedHealthcare offers a Medicare Advantage plan in your area known as UnitedHealthcare Dual Complete® (HMO D-SNP). It is a Dual Special Needs Plan (D-SNP) for individuals who are eligible for both Medicaid and Medicare.Jan 1, 2021

What qualifies you for Medicaid in NY?

Who is eligible for New York Medicaid?

Pregnant, or.
Be responsible for a child 18 years of age or younger, or.
Blind, or.
Have a disability or a family member in your household with a disability, or.
Be 65 years of age or older.

How does Medicaid work in NY?

New York Medicaid Benefits. New York Medicaid benefits include regular exams, immunizations, doctor and clinic visits, relevant medical supplies and equipment, lab tests and x-rays, vision, dental, nursing home services, hospital stays, emergencies, and prescriptions.

What is the maximum income to qualify for Medicaid in NY?

Qualifying When Over the Limits

In 2022, the medically needy income limit is $934 / month for a single applicant and $1,367 / month for a couple.Jan 10, 2022

What is the number to call for Medicaid in NYC?

Those living in the five boroughs of NYC, whose cases are administered by the Human Resources Administration (HRA) office can call the HRA Infoline at 1 (718) 557-1399 or the HRA Medicaid Helpline at 1 (888) 692-6116.

Who can apply for medicaid?

Your category might be single, childless couples, pregnant women, parent (s) and caretaker relatives with dependent children, elderly and/or disabled.

How to report Medicaid fraud?

You can report Medicaid fraud by calling the Fraud Hotline 1-877-873-7283 or by filing a complaint online.

How to order a new medicaid card?

If your Medicaid is with your LDSS, to order a new Medicaid Benefit Identification Card, please call or visit your local department of social services.

How long does it take to get a look back on Medicaid?

This is known as the "lookback" period. Currently the "lookback" period is 60 months (5 yrs) prior to the month you are applying for coverage of nursing home care.

What happens if you are enrolled in managed care in a new county?

If you are currently enrolled in a managed care plan that is not offered in the new county, your local department of social services will notify you so that you can choose a new plan. If your Medicaid is with the Marketplace, (NY State of Health), it is important that you update your account with your new address.

When does Medicaid recover from your estate?

If you receive medical services paid for by Medicaid on or after your 55th birthday , or when permanently residing in a medical institution, Medicaid may recover the amount of the cost of these services from the assets in your estate upon your death.

What is the eligibility for Medicaid in New York?

For New York long-term care Medicaid eligibility, an applicant must have a functional need for such care. This most commonly means one must require a nursing facility level of care. Furthermore, additional criteria may need to be met for some program benefits.

What is Medicaid in New York?

New York Medicaid Definition. Medicaid is a wide-ranging, state and federally funded, health care program for low-income individuals of all ages. While there are several different eligibility groups, including pregnant women, children, and disabled individuals, this page is focused on Medicaid eligibility for New York senior residents ...

What are countable assets for Medicaid?

Countable assets (often called resources) include cash, stocks, bonds, investments, vacation homes, and savings and checking accounts. However, for Medicaid eligibility purposes, there are many assets that are considered exempt (non-countable). Exemptions include IRA’s and 401K’s in payout status, personal belongings, household items, a vehicle, burial funds up to $1,500, and pre-paid funeral agreements (given they cannot be refunded). One’s primary home is also exempt, as long as the Medicaid applicant lives in the home or has intent to return home, and his/her home equity interest is under $906,000. (Equity interest is the amount of the home’s value of which the applicant outright owns). There is one exception to the home exemption rule, which is if the applicant’s spouse lives in the home. If this is the case, the house is exempt regardless of where the applicant spouse lives and his/ her home equity interest.

How long does it take for Medicaid to look back in New York?

At the time of this update, the look back rule only applies to Institutional Medicaid and is a period of 60 months (5 years) that immediately precedes one’s Medicaid application date.

What is considered income for Medicaid?

What Defines “Income”. For Medicaid eligibility purposes, all income that one receives from any source is counted towards the income limit. This may include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, gifts, and payments from annuities and IRAs.

Is Medicaid managed care in New York?

Make note, Medicaid in New York is sometimes referred to as Medicaid Managed Care. Medicaid for the Disabled, Aged or Blind (DAB) is also known as NON-MAGI. The American Council on Aging now offers a free, quick and easy Medicaid eligibility test for seniors.

When will the look back period be implemented in New York?

An important change is coming July 1, 2021; the Look-Back Period will be implemented for home and community based long-term care services (formally referred to as Community Medicaid in NY), such as home health care, adult day care, personal care assistance, and assisted living services.

What is the Medicaid program?

A Medicaid program that pays some of the costs not covered by Medicare for Medicare beneficiaries with incomes under 135% of the federal poverty level (FPL). More information on the Medicare savings program can be found at http://www.nyhealth.gov/health_care/medicaid/program/update/savingsprogram/medicaresavingsprogram.htm

What is Medicare Advantage?

A Medicare drug plan offered through a Medicare Advantage plan (such as an HMO) that offers Medicare prescription drug coverage.

Do patients pay for formulary drugs?

Patients pay varying co-pays for drugs that are on formulary. For drugs that are not on formulary, patients must pay the entire cost of the drug. Formularies vary between drug plans and differ in the breadth of drugs covered and costs of co-pay and premiums.

Which pays first, Medicare or Medicaid?

Medicare pays first, and. Medicaid. A joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid. pays second.

What is original Medicare?

Original Medicare. Original Medicare is a fee-for-service health plan that has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles). or a.

What is not covered by Medicare?

Offers benefits not normally covered by Medicare, like nursing home care and personal care services

Does Medicare have demonstration plans?

Medicare is working with some states and health plans to offer demonstration plans for certain people who have both Medicare and Medicaid and make it easier for them to get the services they need. They’re called Medicare-Medicaid Plans. These plans include drug coverage and are only in certain states.

Does Medicare cover health care?

If you have Medicare and full Medicaid coverage, most of your health care costs are likely covered.

Does Medicare Advantage cover hospice?

Medicare Advantage Plans provide all of your Part A and Part B benefits, excluding hospice. Medicare Advantage Plans include: Most Medicare Advantage Plans offer prescription drug coverage. . If you have Medicare and full Medicaid, you'll get your Part D prescription drugs through Medicare.

Can you get medicaid if you have too much income?

Even if you have too much income to qualify, some states let you "spend down" to become eligible for Medicaid. The "spend down" process lets you subtract your medical expenses from your income to become eligible for Medicaid. In this case, you're eligible for Medicaid because you're considered "medically needy."

What happens if you don't enroll in Medicare Part D?

If a member is not enrolled in a Medicare Part D drug plan, the member will not have any prescription coverage from EPIC or receive any EPIC benefits. Because EPIC is a State Pharmaceutical Assistance Program, EPIC can provide: a Medicare Special Enrollment Period (SEP) so that a new member may enroll in a Part D drug plan at any time during ...

What is a SEP in Medicare?

a Medicare Special Enrollment Period (SEP) so that a new member may enroll in a Part D drug plan at any time during the year; a Medicare one-time plan change per calendar year for existing members; co-payment assistance after the Medicare Part D deductible is met, if the member has one.

What is extra help for Medicare?

Extra Help from Medicare comes in two levels – full and partial. All levels of Extra Help provide a Low Income Subsidy (LIS) with reduced co-payments for approved drugs. Drug co-payments are as low as $9.20 for brand or $3.70 for generic drugs in 2021 when enrolled in a Part D drug plan.

Do you have to pay EPIC fees for Medicare?

Those approved for full Extra Help, a Medicare Savings Program or a Medicaid Spenddown do not have to pay any EPIC fees. EPIC will continue to pay Medicare Part D plan premiums for LIS members, and those with Full LIS in enhanced plans or Medicare Advantage plans up to the basic amount ($42.27 per month in 2021) after Medicare premium subsidization.

Does EPIC cover Medicare Part D?

co-payment assistance after the Medicare Part D deductible is met, if the member has one. EPIC also covers approved Part D-excluded drugs once a member is enrolled in a Part D drug plan.

How much does a single beneficiary get for Medicaid?

This equates to $17,226 annually for single beneficiaries and $23,274 for married couples. Beneficiaries qualify for full Medicaid benefits if their incomes and assets are even lower (but the exact amounts vary by state).

What is dual eligible Medicare?

Beneficiaries with Medicare and Medicaid are known as dual eligibles – and account for about 20 percent of Medicare beneficiaries (12.1 million people). Dual eligibles are categorized based on whether they receive partial or full Medicaid benefits. Full-benefit dual eligibles have comprehensive Medicaid coverage, ...

Does Medicare pay for long term care?

But this is not the case for things Medicare doesn’t cover, like long-term care. If Medicaid is covering a beneficiary’s long-term care, Medicare will still be the primary payer for any Medicare-covered services – like skilled nursing care or physical therapy.

Is Medicare the same as Medicaid?

The federal government oversees Medicare eligi bility – meaning it is the same in each state. But states set their own eligibility rules for Medicaid and the MSPs (within federal guidelines) – and income limits for these programs vary widely.

Do seniors qualify for medicaid?

Many seniors who live in nursing homes are dual eligible: they qualify for Medicare based on their age, and Medicaid because of their financial circumstances.

Can you switch Medicare Advantage and Original Medicare?

Beneficiaries who are dual eligible can change between Original Medicare and Medicare Advantage or switch Part D plans at each quarter.