Medicaid Spenddown for Seniors and People with Disabilitie
Medicaid Spenddown is a program that helps seniors and people with disabilities meet income limits to qualify for Medicaid by using medical expenses. Learn how it works, eligibility criteria, and examples like Jenny who navigates her income to access Medicaid benefits.
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Presentation Transcript
Medicaid Spenddown Guide Last updated June 2024 1
What is Medicare? Health insurance available to people 65+ or under 65 and disabled. What is Medicaid? Medicare vs Medicaid Low-income health insurance available to anyone who meets the income and asset limits. What does it mean to have both? You become dual eligible , meaning Medicaid pays for the healthcare costs that Medicare does not cover. 2
Medicaid Seniors 65+ and people with disabilities can normally get Medicaid in addition to Medicare if they earn less than.... $1,280.00 for individual or $1,728.00 for a couple Have less than $17,500.00 in assets 3
Medicaid and Medicare If you have Medicare, Medicaid is supplemental insurance that pays whatever Medicare doesn t cover. You can have Medicaid if you have a Medicare Advantage plan You must go to a provider who accepts Medicaid to use your Medicaid insurance Medicaid also covers dental, vision, and hearing services 4
What if you make more than the income limit for Medicaid? You may still be able to get it! 5
If you have paid or unpaid medical expenses from the past 6 months you can use them to spenddown to meet the Medicaid income limit. Medicaid Spenddown Program If you are married or if you have a dependent child, you can use their medical expenses too. 6
Meet Jenny Jenny lives alone. She has Medicare but also wants Medicaid. She meets the asset limit but earns $1,500.00 a month from Social Security Retirement Benefits. 7
The income limit for Jenny to get Medicaid is $1,280.00 a month. $1500 (Jenny's income) - $1280 (Medicaid income limit) = $220.00 $220 is Jenny s Spenddown amount! 8
Whenever Jenny collects more than $220.00 in medical bills to show to the state, they will give her Medicaid coverage for the following month! This is called meeting a spenddown . Jenny can combine any number of medical bills from the past 6 months. She can also use bigger medical bills to get multiple months of coverage. 9
If Jenny doesnt have $220.00 in medical bills one month she can: Opt not to get Medicaid coverage for that month Pay $220.00 to get her Medicaid coverage Submit as many medical bills as she can, and then pay the remaining amount Remember! If Jenny shows one big bill, she can spread it out and give herself up to 6 months of coverage 10
What counts as a Medical Bill? Health insurance premiums count as bills! Any bill you submit should have: The name of the person the bill is made out to A date from the past 6 months The name and address of the doctor or facility that is billing you What the bill is for 11
What doesnt count as a Medical Bill? No handwritten notes or personal ledgers No bank statements or credit card bills Nothing that says this is not a bill in tiny letters A bill without a date 12
Call us! Lots of different things can count as medical expenses, including health insurance premiums, pharmacy receipts, and more If you have Social Security disability or are over 65 and have lots of medical bills, call us! 13
