who should i talk to about how to do a spend down for medicare

Spending down your money and assets on the following expenses is ordinarily acceptable by most states' Medicaid

programs. Each state is different, however, so these examples are given for illustration purposes only. You should look into your state's law or consult an estate planning lawyer before engaging in any of these spend-down methods.

Full Answer

How can I find out more about Medicaid spend down programs?

To learn more about your state’s Medicaid spend down program or to receive help with countable assets, allowable expenses and more, you can contact your state’s Medicaid program. While Medicare and Medicaid are two different programs, some people may be eligible for both Medicare and Medicaid.

How do I talk to a live person at Medicare?

Medicare.gov Live Chat is available 24 hours a day, 7 days a week, except some federal holidays. For questions about your claims or other personal Medicare information, log into (or create) your secure Medicare account , or call us at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. What state do you live in?

Does Medicare spend down exist?

“Medicare Spend Down” is simply a misnomer. Medicare has no asset limit and therefore Medicare spend down does not exist. Not all assets held by the applicant are counted towards Medicaid’s asset limit. When determining if one is over the asset limit, it’s critical to know which assets are counted and which are not.

Can I spend down my assets to qualify for Medicaid?

The process of reducing the value of your assets to qualify for Medicaid is referred to as "spending down." One misconception is that the only way to reduce the value of one's assets is to spend them on the Medicaid applicant's medical care.

What assets are exempt from Medicare?

Exempt AssetsPrimary Residence. An applicant's primary residence is exempt if it meets a few fundamental requirements. ... Car. ... Funeral and Burial Funds. ... Property for Self-Support. ... Life Insurance Policies.

How much money can you have in the bank and still qualify for Medi-Cal?

To find out if you qualify for one of Medi-Cal's programs, look at your countable asset levels. You may have up to $2,000 in assets as an individual or $3,000 in assets as a couple. As of July 1, 2022 the asset limit for some Medi-Cal programs will go up to $130,000 for an individual and $195,000 for a couple.

How do I spend down to qualify for Medi-Cal?

Also called a Spend Down program, one's “excess income,” the amount that is determined as one's cost of share, is used to cover medical bills. Once one has paid their share of cost, they will be eligible for Medi-Cal for the remainder of the month. The asset limits remain the same as above.

What is the max income for Medicaid in NY?

Who is eligible for New York Medicaid?Household Size*Maximum Income Level (Per Year)1$18,0752$24,3533$30,6304$36,9084 more rows

Does Medi-Cal check your bank accounts?

Because of this look back period, the agency that governs the state's Medicaid program will ask for financial statements (checking, savings, IRA, etc.) for 60-months immediately preceeding to one's application date. (Again, 30-months in California).

What is the maximum income to qualify for Medi-Cal 2021?

For dependents under the age of 19, a household income of 266 percent or less makes them eligible for Medi-Cal. A single adult can earn up to $17,775 in 2021 and still qualify for Medi-Cal. A single adult with one dependent can earn up to $46,338 annually and the child will still be eligible for Medi-Cal.

What is the maximum income to qualify for Medi-Cal 2020?

According to Covered California income guidelines and salary restrictions, if an individual makes less than $47,520 per year or if a family of four earns wages less than $97,200 per year, then they qualify for government assistance based on their income.

What is the monthly income limit for Medi-Cal 2022?

In 2022, the monthly income will increase to $1,564. In other words, an adult can earn up to $1,564 per month and still qualify for no cost Medi-Cal. MAGI Medi-Cal annual amounts for a single adult increased to $18,755, from $17,775 in 2021, for a single adult.

What does Medi-Cal spend down mean?

What Is a Medicaid Spend Down? A Medicaid spend down is a financial strategy used when an individual's income is too high to qualify for Medicaid. To be accepted into the program, some of the individual's income must be spent down to ensure his or her income is low enough to qualify for Medicaid.

How much money can you have in the bank to qualify for Medicare in NY?

Income eligibility: The income limit is $875 a month if single and $1,284 a month if married. (This is equal to 84 percent of the federal poverty level.) Asset limits: The asset limit is $15,750 for single applicants and $23,100 if couples.

How can I hide money from Medicaid?

Medicaid Asset Protection Trusts are set up to protect money from Medicaid. MAPTs protect money from Medicaid by converting countable assets into non-countable assets. This type of trust essentially allows someone to qualify for Medicaid who otherwise would have been over Medicaid's limits.

What is considered low income for a single person in 2021?

2021 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIAPersons in family/householdPoverty guideline1$12,8802$17,4203$21,9604$26,5005 more rows

What Is Medicaid Spend Down?

The Medicaid spend down program offers a way for beneficiaries with high medical expenses to qualify for Medicaid. Learn more about how this program works and find out if you’re eligible in your state.

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Why is spending down important?

Understanding spend down. The concept of spend down comes into play because income and assets above a certain level disqualifies applicants for long-term care under Medicaid. Spending down is a way to legally bring income and assets in line with eligibility requirements.

What is asset spend down?

Asset spend down: Spending resources down to meet the asset ceiling set by Medicaid. Countable assets: Sometimes referred to as non-exempt assets or liquid assets that can easily be converted to cash because these assets count toward the maximum you can possess for Medicaid eligibility. Examples are bank accounts, vacation homes, stocks and bonds. ...

How long does it take for Medicaid to look back?

This period is 60 months in most states and 30 months in California.

How many people are covered by medicaid in 2019?

Funding appropriation is a joint effort by the states and the federal government. Medicaid reports that 63.9 million people were covered at the end of 2019.

Who is eligible for medicaid?

Eligible beneficiaries include low-income adults, children, pregnant women, the elderly and people with disabilities, according to the official Medicaid website.

What are some examples of assets that can be spent down?

Following are examples of some ways people spend down assets: Pay off credit card balances, a mortgage, or personal or auto loans. Buy medical items not covered by your health insurance, such as dentures, glasses and hearing devices.

How much can a married couple keep on Medicaid?

Typically, the spouse who is applying for Medicaid is able to keep $2,000 in non-exempt assets, while the healthy spouse can keep up to $128,640 (in 2020).

How much can you spend on Medicaid in NJ?

NJ has a countable asset limit of $2,000 for long-term care Medicaid. You are currently over the limit because you have $20,000 in savings. You spend $18,000 adding a downstairs bathroom and a wheelchair ramp to your house, and now you are asset eligible for Medicaid.

What is the asset limit for Medicaid in 2020?

Again, there are exceptions to this rule. For instance, in 2020, the asset limit in this situation for long-term care is $4,000 in Arizona, $6,000 in North Dakota, and $23,100 in New York. Married Couples with Only One Spouse Applying for Medicaid.

How much can a healthy spouse keep in California?

And his wife, the “healthy spouse,” is able to keep up to $128,640 of their joint assets. (California is a 100% state, which means the healthy spouse can keep 100% of their joint assets up to $128,640). This means the couple has $22,3600 ($150,000 – $128,640 = $21,360) in excess of the Medicaid asset limit.

What is excess income on medicaid?

In simple terms, excess income, income over the Medicaid income limit, is directly deposited into an account each month. It is then spent on the elderly individual’s care and / or medical expenses. To learn more about this option, click here. As with the medically needy option, not all states allow QITs.

What are the requirements for Medicaid?

To qualify for Medicaid or Medicaid long term care, seniors must meet several eligibility requirements, including having a need for care and having limited income and assets. These limits vary by state, by marital status (single versus married), and, in many states, by program.

Do you have to spend down Medicaid?

While one may know it’s necessary to spend-down some of their countable assets to qualify for Medicaid, the exact amount that needs to be spent down may be unclear. This is because the asset limit varies by state, as well as if one is single or married, and if married, if one or both spouses are applying for Medicaid.

What is Medicaid Spend Down?

A Medicaid spend down is a financial strategy used when an individual's income is too high to qualify for Medicaid. To be accepted into the program, some of the individual's income must be spent down to ensure his or her income is low enough to qualify for Medicaid. You can apply for Medicaid through your state Medicaid agency, ...

What are some examples of health care costs that you might put toward a Medicaid spend down?

Some examples of health care costs that you might put toward a Medicaid spend down include: Medical bills, past and current. Transportation services to get medical care. Home improvements to help with medical care, like a chair-lift. Medical expenses, such as eyeglasses or a hearing aid.

How does an asset spend down work?

The individual would spend down all eligible assets needed to be eligible to receive benefits, according to the threshold designated by the state. Fortunately, that doesn't mean anybody has to give up a house or a car.

Is Medicaid not available if you have Social Security?

If the Medicaid recipient is receiving Social Security income, then this option is not available because having Social Security income will impose a three year penalty period for any uncompensated transfers, she says.

Does Medicaid pay for nursing care?

However, keep in mind, each state regulates Medicaid spend-down eligibility differently and the process can be overwhelming and stressful, since Medicaid won't pay for medical or nursing care until you've submitted the medical bills that will make up the spend down amount.

When do you lose your Medicaid eligibility?

Medicaid individuals are automatically "deemed" eligible for the LIS and remain eligible until the end of the calendar year in which they lose their Medicaid eligibility. All States have a range of "benchmark" Part D plans. Benchmark plans are considered average Medicare plans.

What happens when a plan denies coverage of a prescription?

When a plan denies coverage of a prescription, the individual has the right to request an exception for coverage of the drug. The individual receives a written decision on any exception requested. If the drug charge appears on the statement as a denial, and no exception was requested, do not allow the charge.

How much is Joe's Medicare deductible?

Medicare assigned $1,068 to Joe's Medicare deductible and charged him an additional $2670 for coinsurance. Medicare paid $6,800 to the hospital. The hospital did an insurance adjustment for the remaining balance. If Joe is eligible for QMB coverage, his charges of $1,068 and $2,670 will be paid by the QMB program and can't be used ...

How many levels of Medicare are there?

In summary, the Medicare Savings Program has four levels of coverage, based on income, with the lowest income standard to qualify for QMB and the highest income standard to qualify for QDWI. MN resource standards also apply.

Does HCA pay for QMB?

HCA pays Part A premiums when the individual is eligible for the QMB (S03) program or the Qualified Disabled Working Individual (QDWI) (S04) program in ACES. HCA allows Part A premium expenses for spenddown only if:

Does HCA pay Medicare Part C?

Medicare Part C. Part C premiums are paid by the individual; HCA no longer pays them. Part C is an option for Medicare individuals who choose to receive Medicare services through a Managed Care plan instead of through the original Medicare fee-for-service program. Part C coverage is also known as Medicare Advantage.

Is Medicare Part D voluntary?

Part D enrollment is voluntary, so not all Medicare individuals will be enrolled in a Medicare Part D plan (PDP) or a Medicare Part C Advantage Plan (MA-PD) when HCA first receives a medical application. However, under WAC 182-503-0505, Part D enrollment is a condition of eligibility for Medicaid coverage.

What is Medicaid needs based?

Medicaid is a "needs-based" program, and a successful Medicaid applicant must have insufficient assets to pay for one's own care. Federal law establishes a benchmark for the amount of resources an individual may own to qualify for the program. The process of reducing the value of your assets to qualify for Medicaid is referred to as "spending ...

What are some examples of Medicaid debt?

Examples include credit cards, mortgage payments, medical bills, taxes, car payments, rent, utilities, and the costs of home or car maintenance.

Can you prepay a Medicaid loan?

Pre-Payment. In the case of a mortgage, auto loan, or other type of loan, the Medicaid applicant can prepay the loan off, since he or she is legally obligated by the loan contract to pay the full amount of the loan, even though monthly payments are authorized. This does not hold true, however, in all cases of money owed.

Do you have to have a written agreement with a caregiver?

Every state has their own set of rules that must be complied with, but usually they require the applicant to have a written agreement with the caregiver. As a general rule (as mentioned earlier), keep in mind that prepayment for future caregiver services will not be allowed.

Can you be paid in advance for a caregiver on medicaid?

Medicaid will not allow for a caregiver to be paid in advance for services not yet provided. A pre-payment for services not yet provided will be treated as a gift, and will result in a period of Medicaid ineligibility.

Is spending down your money on Medicaid acceptable?

Permissible Expenses. Spending down your money and assets on the following expenses is ordinarily acceptable by most states' Medicaid programs. Each state is different, however, so these examples are given for illustration purposes only.

Can you prepay utilities?

Pre-payment of utilities is normally not allowed, since no benefit has been provided in the form of future services, and the individual has the legal right to terminate a utility at any time. Pre-payment of medical services, medications, or rent is also not allowed for the same reasons. Purchasing Noncountable Assets.

What are countable assets for Medicaid?

Countable assets are anything Medicaid counts toward the countable asset limit set by your state. Countable assets include: Cash. Bank accounts—checking or savings accounts. Property other than your primary home. Retirement accounts (varies by state) Investment assets like CDs, stocks, bonds, mutual funds, and others.

What is irrevocable medical trust?

An irrevocable medical trust is money set aside that becomes part of the trust that pays out to certain beneficiaries. This money is permanently placed in the trust and managed by somebody other than the person or their spouse. Often the money pays out to beneficiaries once the person passes away but it can also be paid to the original Trustor—generally not for at least five years after the trust is established. Trusts are complicated and creating one to qualify for Medicaid adds an additional level of complexity. Trusts require an estate attorney.