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). There are two types of Medicaid. Community Medicaid and Nursing Home Medicaid.
Community Medicaid eligibility criteria differs by category. In 2023, New York had a significant increase in the amount of both income and resources that can be retained in order to qualify for Medicaid. For a single aged (65 and over), blind or disabled individual, the asset limitation is now $28,133 for 2023. The income limit for an applicant living in the community is $1,563.00 per month, as well as 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 $37,902.00 and the income level is $2,106.00 per month. If income anbd/or resources are in excess of the applicable limits, there are planning techniques available that could still secure community Medicaid. Seek the advice of a knowledgeable Elder Law attorney.
Nursing Home Medicaid eligibility criteria for a single person is the same income and resource levels as Community Medicaid eligibility. If married, the income and resource allowance of the "well" or "community spouse" can be significantly more than under community Medicaid. What a community spouse may retain is dependent on the extent of the couples income and resources. Minimally, a community spouse, in 2023, can retain income (whether their own or with a contribution from the "ill" spouse) of $3,715.50, and resources of somewhere between $74,820.00 and $148,620 In many, if not most circumstances, significantly more resources can be retained by the community spouse. CAUTION: With some exceptions, Medicaid will impose periods of ineligibility for most transfers of assets made within five years of application to anyone other than the spouse of the institutionalized spouse! In order to maximize the resources that can be retained by the community spouse, seek the advice of a knowledgeable Elder Law attorney.
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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 $128,640.00 depending on the value of resources at the time of institutionalization). However, depending on the financial circumstances of the couple, it is usually possible to retain assets far in excess of this figure. Seek the advice of a knowledgeable Elder Law attorney who can help maximize the resources that can be saved for the community spouse.
Medicaid will also allow the community spouse to retain a "minimum monthly maintenance needs allowance" (MMMNA) income of 3,216.00. If the community spouse's income is less than this figure, 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 resources exceed the resource level, there are techniques available that may allow the community spouse to retain all or a portion of the excess resources. Seek the advice of a knowledgeable Elder Law attorney who can help maximize the resources that can be saved for the community spouse.
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