What is the difference between Medicaid and Medicare?
Who is eligible for Medicaid?
If I need a nursing home, but my spouse does not, will I still be able to get Medicaid?
Q: What is the difference between Medicaid and Medicare?
Medicare is a federal health insurance program associated with Social Security Insurance benefits for the elderly and disabled that assists in paying for medical expenses, but does not pay for extended nursing home care or prescription drugs. Medicaid is a joint federal-state assistance program based on financial need, which comprehensively pays for the medical and health maintenance needs of those receiving coverage. It also pays for long term nursing home care for individuals and members of couples.
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Q: Who is eligible for Medicaid?
Medicaid is available to the elderly, disabled, blind, children, and other groups in need of coverage elder individuals who meet the financial eligibility rules, and for those persons eligible for Supplemental Security Income (SSI). Medicaid eligibility criteria differs by category, but for a single aged (65 and over), blind or disabled individual, the asset limitation is $14,200.00. The income limit for an applicant living in the community is $792.00 per month (plus any amount used towards a secondary health insurance), although excess income may be "spent down" on medical care to receive benefits. For a couple, the resource level is $20,850.00 and the income level is $1,159.00 per month. If resources are in excess of the applicable limit, there are planning techniques available that could secure community Medicaid. Seek the advice of a knowledgeable Elder Law attorney. For nursing home coverage, all monthly income over $50.00 must be paid to the nursing home, although there are exceptions if there is a spouse still living in the community.
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Q: If I need a nursing home, but my spouse does not, will I still be able to get Medicaid?
Yes. A portion of the couples' countable assets are called the community spouse resource allowance (CSRA). Medicaid generally allows the community spouse to keep a home, a car, and other resources which are no more than $74,820.00 (sometimes up to $113,640.00 depending on the value of resources at the time of institutionalization). However, depending on the financial circumstances of the couple, it is quite possible to retain assets in excess of this figure.
Medicaid will also allow the community spouse to retain a "minimum monthly maintenance needs allowance" (MMMNA) [iincome] of $2,841.00. If the community spouse's income is less than this fugure, he/she is entitled to all or a portion of the institutionalized spouse's income to bring the community spouse's income up to this level. If the combined income is less than this figure, and if resourrces exceed the resource level, there are techniques available that may allow the community spouse to retain all or a portion of the excess resources.
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