why can't i qualify for medicaid since i got medicare

Many recipients of Social Security disability insurance (SSDI) have incomes that are too high to qualify for Medicaid

under these traditional rules. And with only a few limited exceptions, people who qualify for SSDI benefits don't become eligible for Medicare until two years after the date they become entitled to receive benefits.

Full Answer

Can you own a home and still qualify for Medicaid?

The home is one of the biggest assets you are allowed to own and still qualify for Medicaid coverage of your nursing home bills. Under recent federal law effective Jan. 1, 2006, the equity in your home will be completely exempt from counting against you for Medicaid eligibility purposes, if your equity does not exceed $500,000.

Why don't I qualify for SSDI?

One of the main reasons that many claimants are denied SSI (Supplemental Security Income) or SSDI benefits is because they do not have adequate medical records to prove that they are disabled and unable to work. Getting great medical care costs money.

How to lose Medicaid coverage?

• You no longer have a qualifying disability
• You fail to pay your plan premiums
• You move outside your plan’s coverage area
• Your plan is discontinued
• You lied or provided misleading information on your plan application
• You engage in Medicare fraud or “disruptive behavior”

When do you lose Medicaid?

• Impairment-related work expenses; or
• Blind work expenses; or
• A plan to achieve self-support; or
• Personal attendant whose fees are publicly funded; or
• Medical expenses above the average State amount.

What is the lowest income to qualify for Medicaid?

Federal Poverty Level thresholds to qualify for Medicaid The Federal Poverty Level is determined by the size of a family for the lower 48 states and the District of Columbia. For example, in 2022 it is $13,590 for a single adult person, $27,750 for a family of four and $46,630 for a family of eight.

What are the disadvantages of Medicaid?

Disadvantages of Medicaid They will have a decreased financial ability to opt for elective treatments, and they may not be able to pay for top brand drugs or other medical aids. Another financial concern is that medical practices cannot charge a fee when Medicaid patients miss appointments.

Who is eligible for Medicaid NY?

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.

Which state has best Medicaid program?

New YorkStates with the Best Medicaid Benefit ProgramsRankStateTotal Spending Per Person1New York$12,5912New Hampshire$11,5963Wisconsin$10,0904Minnesota$11,63346 more rows•Jun 16, 2020

Is Medicare better than Medicaid?

Medicaid and Original Medicare both cover hospitalizations, doctors and medical care. But Medicaid's coverage is usually more comprehensive, including prescription drugs, long-term care and other add-ons determined by the state such as dental care for adults.

What is the monthly income limit for Medicaid in NY?

Also called a Spenddown Program or Surplus Income Program, one's “excess income” is used to cover medical bills, such as medical supplies, prescription drugs, and doctor visits. In 2022, the medically needy income limit is $934 / month for a single applicant and $1,367 / month for a couple.

How much do you have to make to qualify for Medicaid in NY?

+How do I know if my income and resources qualify me for Medicaid?Family SizeMedicaid Income Level for Single People & Couples without ChildrenNet Income for Families and Individuals who are Blind, Disabled or Age 65+AnnualAnnual1$18,755$11,2002$25,268$16,4003$31,782$18,8608 more rows

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

For example, a single person can have up to $15,750 in resources and still qualify for Medicaid. A family of two can have up to $23,100. For non-disabled individuals under 65 who don't receive nursing home care, there is no limit to the amount of assets they can own; Medicaid simply looks at their income.

What if I don't qualify for medicaid?

If you don't qualify for Medicaid, we'll tell you if you qualify for financial help to buy a Marketplace health plan instead. (But unless you qualify to enroll with a Special Enrollment Period, you'll have to wait until the next Open Enrollment Period.)

Can I buy a private health plan through the Marketplace?

You may be able to buy a private health plan through the Marketplace instead for the 2018 plan year in the fall. You may qualify for savings based on your income through a premium tax credit and savings on out-of-pocket costs. If you don't qualify for either Marketplace or Medicaid savings, you still have options. Learn more here.

Can I qualify for medicaid based on my income?

No matter your state, you may qualify for Medicaid based on your income, household size, disability, family status, and other factors. But if your state has expanded Medicaid coverage, you can qualify based on your income alone. Enter your household size and state.

How old do you have to be to qualify for medicare?

Citizens or legal residents residing in the U.S. for a minimum of 5 years immediately preceding application for Medicare. Applicants must also be at least 65 years old. For persons who are disabled or have been diagnosed with end-stage renal disease or Lou Gehrig’s disease (amyotrophic lateral sclerosis), there is no age requirement. Eligibility for Medicare is not income based. Therefore, there are no income and asset limits.

How to apply for medicaid?

How to Apply. To apply for Medicare, contact your local Social Security Administration (SSA) office. To apply for Medicaid, contact your state’s Medicaid agency. Learn about the long-term care Medicaid application process. Prior to applying, one may wish to take a non-binding Medicaid eligibility test.

How much does Medicare Part B cost?

For Medicare Part B (medical insurance), enrollees pay a monthly premium of $148.50 in addition to an annual deductible of $203. In order to enroll in a Medicare Advantage (MA) plan, one must be enrolled in Medicare Parts A and B. The monthly premium varies by plan, but is approximately $33 / month.

What is Medicare and Medicaid?

Differentiating Medicare and Medicaid. Persons who are eligible for both Medicare and Medicaid are called “dual eligibles”, or sometimes, Medicare-Medicaid enrollees. Since it can be easy to confuse the two terms, Medicare and Medicaid, it is important to differentiate between them. While Medicare is a federal health insurance program ...

What is dual eligible?

Definition: Dual Eligible. To be considered dually eligible, persons must be enrolled in Medicare Part A, which is hospital insurance, and / or Medicare Part B, which is medical insurance. As an alternative to Original Medicare (Part A and Part B), persons may opt for Medicare Part C, which is also known as Medicare Advantage.

What is the income limit for Medicaid in 2021?

In most cases, as of 2021, the individual income limit for institutional Medicaid (nursing home Medicaid) and Home and Community Based Services (HCBS) via a Medicaid Waiver is $2,382 / month. The asset limit is generally $2,000 for a single applicant.

Does Medicare cover out-of-pocket expenses?

Persons who are enrolled in both Medicaid and Medicare may receive greater healthcare coverage and have lower out-of-pocket costs. For Medicare covered expenses, such as medical and hospitalization, Medicare is always the first payer (primary payer). If Medicare does not cover the full cost, Medicaid (the secondary payer) will cover the remaining cost, given they are Medicaid covered expenses. Medicaid does cover some expenses that Medicare does not, such as personal care assistance in the home and community and long-term skilled nursing home care (Medicare limits nursing home care to 100 days). The one exception, as mentioned above, is that some Medicare Advantage plans cover the cost of some long term care services and supports. Medicaid, via Medicare Savings Programs, also helps to cover the costs of Medicare premiums, deductibles, and co-payments.

How old do you have to be to get medicare?

You’re eligible for Medicare if you’re over the age of 65 or on disability for at least 24 months. Although, you apply for Medicare online at the Social Security Administration website.

How long does it take for medicaid to approve?

Approval time for Medicaid can take up to 60 days. Benefits are for US citizens; but, children of illegal immigrants can qualify. If you get Social Security supplemental benefits, you’ll qualify for Medicaid. Also, Medicaid has benefits Medicare doesn’t; this includes vision, dental, and long-term custodial care.

Can you disenroll with Medicare Dual Eligible?

Is there a Special Enrollment Period for Medicare Dual-Eligible? Those with Medicaid and Medicare qualify for a Special Enrollment Period; you can disenroll, join, or switch plans. The Special Enrollment Period begins the month a person is eligible for assistance.

Is Medicare free for low income people?

With Medicare, think “care” for those 65+ or those with disabilities. Then, Medicaid is “aid” to those with a low income. Medicaid is free. Medicare is not free.

Does medicaid cover Medicare?

Criteria for Medicaid can differ between states. Medicaid pays the part that Medicare doesn’t cover with partial dual-eligibility. Further, Medicaid will cover your Part B premiums, and if applicable, Part A. Beneficiaries who qualify for both are dual-eligible.

Is Medicare a federal or state program?

But, just because you have one, doesn’t mean you’ll automatically have the other. Medicare is a federal program, while Medicaid is a state program.

Is medicaid free?

Medicaid is free. Medicare is not free. Those with Medicaid won’t be subject to the Part B premium or Part B late enrollment penalties. But, those with only Medicare will be responsible for applicable costs. Just because Medicaid is free doesn’t mean it’s for everyone. Approval time for Medicaid can take up to 60 days.

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, ...

What is a dual eligible special needs plan?

If you are dual eligible, you are can enroll in a dual eligible special needs plan (D-SNP) that covers both Medicare and Medicaid benefits. These plans may also pay for expenses that Medicare and Medicaid don’t over individually, including over-the-counter items, hearing aids, and vision or dental care. Beneficiaries who are dual eligible can ...

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.

Does Medicare cover 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.

How many people are covered by medicaid?

Medicaid also provides coverage to 4.8 million people with disabilities who are enrolled in Medicare.

Can you be covered by Medicare and Medicaid?

Individuals who are enrolled in both Medicaid and Medicare, by federal statute, can be covered for both optional and mandatory categories.

Can Medicare help with out of pocket medical expenses?

Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid (e.g. MSPs, QMBs, SLBs, and QIs).

What to do if you are no longer eligible for medicaid?

If you are no longer eligible for Medicaid, there are other options that can help you maintain health insurance for you and your family.

What happens if your income rises above the poverty level?

If your income rises above the level your state uses to define Medicaid eligibility, you lose access to the program. Income levels for Medicaid eligibility also take into account family size.

Does income affect Medicaid eligibility?

Income levels for Medicaid eligibility also take into account family size. If you have a child who has aged out of being a dependent, a divorce or death in the family has reduced the amount of people in your home, or your family size has changed in other ways, this may affect your eligibility even if your income is the same.

Can you get short term health insurance if you lose Medicaid?

You can also get short-term health insurance to fill in any coverage gap between when you lose Medicaid and an employer-based or government-subsidized plan starts.

Can you get medicaid if you no longer fit into a group?

If your circumstances change and you no longer fit into one of these categories, you may no longer be eligible for Medicaid.

Can you get medical care if you lose Medicaid?

Because losing Medicaid coverage is considered a qualifying life event, you should qualify for a special enrollment period and be able to get health care even if you have to apply outside the regular yearly enrollment period.

Can you move Medicaid without it?

Some states have opted not to expand Medicaid eligibility under the guidelines allowed by the Affordable Care Act (ACA), so if you move from a state with expanded Medicaid to a state without it, you may lose eligibility.