Seniors often have issues managing healthcare expenses. Medicare doesn’t cover everything, which can be even more of a problem for seniors needing long-term care. However, Medicare and Medicaid dual eligibility could be an option for some seniors.
This post explores dual eligibility to help seniors understand if they qualify.
The Basics of Medicare and Medicaid Dual Eligibility
First, here are some Medicare and Medicaid basics.
Medicare is a federal health insurance program primarily for seniors. It consists of multiple parts covering different things. Part A covers hospitalization, and Part B covers regular outpatient concerns like doctor’s visits and preventative care. Meanwhile, Part D provides prescription drug coverage. And Part C is Medicare Advantage, which is private insurance. You can learn more by clicking here.
Medicaid is a health insurance run jointly by the federal government and your state of residence. Its purpose is to provide health services to low-income individuals. For seniors, it may cover various services not available under Medicare. Medicaid also has multiple programs that may have differing eligibility requirements.
Medicare Eligibility
Eligibility for Medicare is relatively straightforward for seniors. The first requirement is that the individual is over 65. Beyond that, you must be eligible for Social Security benefits. That means you must have paid enough in payroll taxes over your lifetime. Another requirement is that the individual is a US citizen or legal resident.
Medicaid Eligibility
While Medicare is more of an age-based program, Medicaid is a needs-based program. Medicaid sets its criteria mostly on income, assets, and medical needs. Income and asset limits vary by state. They may also vary depending on marital status and medical issues. This post covers Florida Medicaid eligibility. It is also important to note that requirements change over time.
As of this writing, a single individual seeking regular Medicaid can have a maximum monthly income of $1,105. The asset limit for these individuals is $5,000. For Medicaid Waiver programs, the income limit is $2,901, and the asset limit is $2,000.
Dual Eligibility
To be dual eligible, an individual must meet the eligibility criteria for both programs. With dual eligibility, the general rule is that Medicare will pay first, and then Medicaid can help with additional costs. The more significant hurdle to dual eligibility for most seniors is Medicaid requirements. However, there are steps you can take to gain Medicaid eligibility.
One way to gain eligibility is to set up a Medicaid asset protection trust. These trusts remove assets from the individual’s legal ownership while protecting them from Medicaid. However, you must manage look back periods, transferring assets, and more. Seniors should seek assistance from an elder law attorney to ensure compliance and protection.
Do you need help managing dual eligibility or setting up an asset protection trust? Click here to contact the Scott Law Offices. Our elder law experts are ready to help you navigate these complex issues. Reach out now to learn more about our services.
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