There is so much red tape and legal jargon surrounding Medicaid that it can be difficult to determine who is eligible for benefits. If you are balancing the search for quality care for yourself or a loved one while also navigating the bureaucracy of Medicaid coverage, it can feel impossible.
At Legacy Navigation, we are here to support and guide you and your loved ones through this complex process, so you can get the medical benefits that you deserve and keep your estate intact. Read on to learn from the experts at Legacy Navigation about how Medicaid for seniors works.
Is Medicaid Free for Seniors?
Yes and no.
Medicaid does not charge seniors for enrollment. But when using Medicaid or a Medicaid Waiver, the beneficiary may be required to pay a percentage of the overall medical cost according to their income.
Medicaid also keeps a running tab of all medical costs it pays for a beneficiary from the age of 55 onward. After the beneficiary passes away, Medicaid may seek to be reimbursed for all costs from the beneficiary’s estate. This can include the sale of their house, personal possessions, and liquid assets.
To learn more about how Medicaid works for seniors, reach out to Legacy Navigation. We can help get you in touch with a Certified Medicaid Planner™ to ensure that you get the most out of your benefits without costing your loved ones their inheritance.
Criteria for Medicaid Eligibility
Medicaid doesn’t cost anything out-of-pocket for seniors who meet certain requirements. These requirements vary state-to-state, but the general qualifications for free Medicaid are:
- Age 65 or over
- An income limit set by the state
- Have limited assets (homes, cars, investments, burial funds, etc.)
- Be a US citizen or qualifying resident
- Medical necessity for certain long-term care coverage
If a senior citizen makes too much money for Medicaid but still has high medical costs, they can apply for the “Medically Needy” program.
To do this, the beneficiary must “spend down” their income by paying for medical services not covered by insurance. Once their income is lowered to the amount needed to qualify, Medicaid will pay the remainder of the medical expenses.
If this sounds confusing and overwhelming, there are services available to help. Legacy Navigation offers Medicaid planning for seniors in most states, helping you secure quality care without risking family assets.
What Kinds of Services Does Medicaid Cover for Seniors?
Medicaid is supposed to cover certain medical services, though some may require an authorization from a doctor or other red tape. Here is a rough list of the services that Medicaid is supposed to cover for seniors:
- Emergency and hospital services
- Preventive and primary physician care services
- Some home-based healthcare services, like hospice and private duty nurses
- Certain laboratory and X-ray Services
- Pharmaceutical needs
- Medical equipment, such as wheelchairs and hearing aids
- Support services, such as rides to doctors’ appointments and hearing/language disorder services
- Certain specialty services like acupuncture, podiatry, physical therapy, and more
Medicaid Waiver Programs
If a beneficiary requires a medical service that is not covered by standard Medicaid, they may still qualify for a Medicaid Waiver Program. This program allows beneficiaries to get the required care, but may require a small copay, dependent on beneficiary income.
The Medicaid Waiver program may also make a claim against the beneficiary’s estate after they have passed. If this is something you are concerned about, consider working with a Medicaid planning service like Legacy Navigation.
Here are a few examples of care that may require a Medicaid Waiver to be covered:
Personal Care
Personal care services (PCS) provide care for individuals within their home or in a group home/ facility setting. PCS workers assist individuals who require help with daily needs, such as bathing, dressing, eating, etc.
To qualify for personal care covered by Medicaid, the beneficiary must have a disability or cognitive impairment.
Respite Care
Respite care is offered to families who act as the beneficiary’s primary caregiver. These caregivers are often the recipient’s adult child or spouse, and they can experience burnout and a decrease in quality of life.
Respite care provides a certified caregiver for a certain number of days a month, depending on the state, and can be covered by a Medicaid Waiver program.
Adult Day Care
A Medicaid Waiver may also help offset the cost of Adult Day Care, a facility that provides daytime supervision, meals, and socialization for seniors. Adult Day Care allows caregivers respite as well as proper care for loved ones during working hours.
What Kinds of Services Does Medicaid Partially Cover for Seniors?
Lots of people ask if seniors can enroll in both Medicaid and Medicare. Yes, qualifying seniors can be enrolled for both programs, and Medicaid can help cover costs left over from Medicare, helping to alleviate the financial burden. Here is a list of what Medicaid covers for Medicare beneficiaries:
- Part A: Covers medical costs of hospitalization. For some seniors, this has a monthly premium cost that can be offset by a savings program.
- Part B: Covers medical costs of more routine care, like X-rays, physician services, outpatient services, and medical equipment like wheelchairs and hearing aids.
- Part C: Medicare Advantage Plan (like an HMO or PPO). These are usually offered by third-party companies that have Medicare approval.
- Part D: Covers prescription drug costs.
Is Medicaid free for senior citizens? There are no out-of-pocket costs to join Medicaid, and with dual enrollment, the cost of medical care can be free as well. But all of this requires navigating complex paperwork and multiple applications.
There are also several Medicare Savings Programs that are managed by Medicaid and can help qualifying seniors offset the cost of medical care. Read on to learn more about these different savings programs.
Qualified Medicare Beneficiary (QMB)
For some seniors who don’t meet the income requirement, Medicare Part A and Part B coverage requires a monthly premium, as well as deductible costs. Qualified Medicare Beneficiary Programs (QMB) can help pay these monthly premiums and extra costs for seniors whose income exceeds the limit. The asset limits for Qualified Medicare Beneficiary programs are higher than those for full Medicaid.
Specified Low Income Medicare Beneficiary (SLMB)
If a qualified Medicaid-enrolled senior is struggling to pay for Medicare Part B due to low income, they may qualify for a Specified Low Income Medicare Beneficiary (SLMB) that can cover the costs.
Qualifying Individual (QI)
The Qualifying Individual Program can help cover the monthly premium for Medicare Part B. This program is difficult to get into because it has an annual cap on participants, but it can be very helpful to offset overall medical costs for seniors.
Considering these Medicare programs? Get help from Certified Medicaid Planner™ professionals at Legacy Navigation.
Legacy Navigation: Helping Senior Citizens Navigate and Maximize Their Medicaid Benefits
Medicaid benefits for seniors are supposed to help them enjoy their golden years. However, the mountain of paperwork required for enrollment is confusing and exhausting.
If you or a loved one needs Medicaid and cannot navigate the paperwork, reach out to Legacy Navigation. Our Certified Medicaid Planners™ handle everything from the application for benefits to reallocating assets, allowing you to enjoy Medicaid benefits without having to lose your home or car.
Legacy Navigation will work with you to get the most out of your Medicaid benefits, even if your income is too high to qualify. Reach out today and learn how we can help.
