What happens to your health insurance when you retire? Medicare and retirement can seem intimidating, but we’re here to ease some of your concerns and answer your questions.
There are currently an estimated 70 billion baby boomers who are nearing retirement. Planning for retirement is crucial to living a comfortable and healthy life. An annual estimate by Fidelity shows the average couple retiring at age 65 will need $280,000 to cover health-related costs. Fortunately, Medicare can help, but there is a set of guidelines and regulations regarding enrollment.
How Medicare and Retiree Coverage Work Together
Some employers may offer retiree health coverage, which can be a good option if you are not yet 65 and do not meet other Medicare eligibility requirements. If you are 65, it may be time to enroll in Medicare.
If you are already 65 when you retire and are interested in having both retiree coverage from your employer AND Medicare, the two can work together.
Your Medicare coverage will always come first. Your retiree coverage will work as extra coverage to backup your Medicare plan – kind of like a Medicare Supplement plan.
While retiree coverage is not a Medicare Supplement plan, it is very similar. It can cover things like copayments and deductibles, or even extra hospital stay days. All retiree plans are different, though, so look over your plan and call your insurance agent (or your former HR representative) to find out what it covers.
Do Retirees have to Pay for Medicare?
There are two parts to Original Medicare – Part A and B. If you have worked and paid Medicare taxes for at least 40 quarters (about 10 years), you can have premium-free Part A. If you did not work the 40 quarter minimum, then you will have to pay the Part A premium. For 2020, the Part A premium is $458 for 30+ quarters or $252 for 30-39 quarters.
The standard Part B premium for 2020 is $144.60, but you may pay more or less based on your own set of circumstances. An estimated 3.5% of beneficiaries will have a lower premium due to the Social Security “hold harmless” provision which prevents premiums from exceeding Social Security benefits. Plus, if you make more than $87,000 a year, your monthly Part B premium will be adjusted based on your income. The income-based 2019 Part B premiums are as follows:
Do you Automatically get Medicare When you Turn 65?
If you currently receive Social Security benefits, you will be automatically enrolled in Medicare Parts A and B the month you turn 65. However, if you do not receive Social Security benefits, you will need to enroll yourself. Medicare enrollment begins three months before your 65th birthday and will end three months after. This is called your initial enrollment period.
It’s important to act right away because delaying your enrollment can result in a 10% Part B premium increase for every year you’re eligible but don’t enroll. If you don’t select prescription drug coverage and later enroll, you may have a penalty of 1% the national base Medicare Part D monthly premium for each month you were not enrolled.
Health Insurance After Retirement Before Medicare (Early Retirement)
Should you keep working or retire early? Your decision may be influenced by your age, health, budget, Medicare eligibility, social security benefits, and employer coverage.
Employer Retiree Coverage
Some employers offer retiree coverage after you leave the company. However, retiree coverage and Medicare are not the same. Retiree coverage is health coverage that is provided to former employees of a company. This typically pays second to Medicare, which means you still need to enroll in Medicare to be fully covered. However, retiree coverage can help with health-related expenses if you retire before 65.
Not every employer offers retiree coverage. Since it isn’t required, your employer (or former employer) can cancel or change your retiree plan at any time. It’s safest for you to have Medicare as well. Plus, if you don’t enroll in Medicare when you first become eligible, you will face a penalty fee. Some retiree plans automatically stop when you turn 65 and become eligible for Medicare.
If your employer does not offer retiree coverage, retiring or losing your job gives you a SEP. A Special Enrollment Period means that you don’t have to wait for AEP, the Annual Enrollment Period, to buy coverage. You will have 60 days from your last day of work to enroll in a marketplace health plan. After those 60 days are over, you’ll have to wait until AEP (October 15 – December 7) to buy a marketplace plan, at which point you will be charged a penalty fee for having a lapse in coverage.
FERS/CSRS Retirement and Medicare
The CSRS, or Civil Service Retirement Act, became effective on August 1, 1920. It was replaced by the Federal Employees Retirement System (FERS) on January 1, 1987. Some people may still belong to CSRS. Both programs are for government employees only.
Both FERS and CSRS allow you to retire at age 62 if you have five or more years of service or at age 60 if you have 20 or more years of experience. Under FERS, you can retire between ages 55 and 57 (depending on your birth year) if you have 30 or more years of service.
Regardless of your FERS or CSRS status, if you’re 65, you’ll qualify for Medicare. You’ll also qualify for Medicare if you have a qualifying disability. If you are under 65 and do not qualify for Medicare, you can receive your FERS or CSRS benefits but will have to wait until you reach Medicare qualifying age.
Until then, you may qualify for the Federal Employees Health Benefits Program (FEHB). Once you do become eligible for Medicare, you may want to enroll in Part A anyway because there is no premium if you’ve worked for at least 40 quarters.
When you leave your job, you’ll also have the option to enroll in COBRA. COBRA allows you to continue to belong to your employer’s group plan for a temporary period after you leave the company. The company can “kick you off” at any time, so this is not a permanent option. However, COBRA can help you out while you figure out what your other options are.
Ask your employer or your HR representative to find out what COBRA might look like for you.
Can you get Medicare at age 62?
It’s important to understand the differences between Social Security and Medicare. You can start to receive Social Security retirement benefits at the age of 62. This amount is typically reduced until you reach the age of 65. The average person does not qualify for Medicare until age 65, but there are exceptions.
You are automatically enrolled in Medicare once you have received Social Security benefits for two consecutive years. This means if you started receiving benefits at age 62, you will qualify for Medicare at age 64. Plus, you may qualify for Medicare before 65 if you have Lou Gehrig’s Disease (ALS) or End-Stage Renal Disease.
Importance of PlanningforRetirement
It’s never too early to start planning for retirement and Medicare. Our licensed agents can help explain your coverage options and answer all of your questions. Plus, they can provide bias-free assistance with a wide range of plan options because they are licensed with all major carriers in your state. Start planning now! Call us at 833-438-3676 or fill out this form to arrange a no-cost, no-obligation appointment.
This post was originally published on December 27, 2018, and was last updated on November 15, 2019.
A Guide to Medicare Coverage for Dementia
Dementia is a decline in mental capacity that becomes severe enough to hinder a person’s ability to function. According to the Alzheimer’s Association, one-third of Americans die with some form of dementia.
Medicare Parts A and B (Original Medicare) will cover everything that’s medically necessary for dementia patients, but many services won’t be covered.
While Original Medicare dementia care is limited, certain Medicare Advantage plans offer coverage for more services that can include unexpected offerings like meal delivery.
Medicare Coverage for Dementia Patients Clarified
Medicare will cover services that your doctor deems medically necessary. Medicare Part A covers inpatient hospital care, and Medicare Part B covers outpatient care and medical expenses such as doctors’ appointment costs.
Original Medicare will pay for the first 100 days of care in a skilled nursing facility (there may be some associated fees), and some Medicare Advantage (Part C) plans may include long-term care coverage.
Private insurance companies offer Medicare Advantage plans, so they have the freedom to cover benefits Original Medicare doesn’t. Medicare Part D or certain Medicare Part C plans cover prescription drugs such as cholinesterase inhibitors that can temporarily improve symptoms of dementia.
Medicare Supplements (Medigap) plans can help cover the expenses that Original Medicare does not. Unlike Medicare Advantage plans, Medigap plans do not cover medical expenses, but they cover financial items such as Part A and B coinsurance and copayments. Even though Medigap and Medicare Advantage are two different types of plans, you cannot enroll in both at the same time.
Medicare and Dementia Testing
Medicare Part B covers cognitive testing for dementia during annual wellness visits. A doctor may decide to perform the test for patients who are experiencing memory loss.
The test consists of about 30 questions like, “What year is this?” to assess the patient’s memory and awareness. The test can be used as a baseline evaluation for future wellness visits and can be a valuable tool for catching dementia early.
Medicare Testing for Alzheimer’s
Dementia is a symptom that can result from many different diseases. Alzheimer’s disease is just one cause of dementia. The risk of developing Alzheimer’s increases with age and with a family history of Alzheimer’s.
There is a correlation between genes called apolipoprotein E (APOE) and Alzheimer’s, but those genes do not necessarily cause the disease. Medicare will not cover genetic testing for APOE genes.
Dementia as a SEP-Qualifying Condition
Medicare eligibles with dementia also qualify for specific Medicare Advantage plans called Chronic Special Needs Plans (CSNPs). These health insurance plans involve coordination and communication between the patient’s entire medical team to help ensure the patient gets the best possible care.
The best way to sort through the thousands of plans available and find the right CSNP for you is enlisting the help of a qualified professional by contacting us here.
If you’re diagnosed with dementia and already enrolled in Medicare Parts A and B, you will qualify for the Special Enrollment Period (SEP). The SEP allows you to enroll in new Medicare coverage or make changes to your existing CSNP whenever you need to instead of having to wait for certain times of the year.
Early Signs and Symptoms of Dementia
Dementia can have a variety symptoms depending on the cause. However, some common signs symptoms include:
Loss of memory
Difficulty finding the right words during conversation
Getting lost while driving to and from familiar places
Difficulty with logical reasoning or solving problems
Difficulty with completing complex tasks
Difficulty with planning and organizing day-to-day activities
Difficulty with muscular coordination and motor functions
Being confused or disoriented
Changes in personality
Inappropriate or irrational behavior
Does Medicare Cover Memory Care?
Memory care is a specific type of long-term care for people with dementia. Original Medicare does not cover assisted living facilities. However, certain Medicare Part C plans may include coverage for Medicare dementia care services such as adult day care or help to get dressed or to bathe.
Medicare.gov has a tool to find nursing homes that accept Medicare for medical services. To get started, click here. Not all of these facilities have dedicated memory care teams, so you’ll need to contact them to verify their services.
Once you’re on the nursing home finder tool page, enter your zip code as shown below in red. We used 37209, which is our corporate headquarters’ zip code in Nashville, Tennessee. Then click “Search,” shown in yellow.
Then you’ll reach a list of nursing homes in your area. The nursing home finder tool lets you sort facilities by star rating, which is based on a scale of one to five.
Basically, the higher the rating, the better the care the facility provides. For demonstration purposes, we only chose to see homes that have a five-star rating (shown below in red) and that take Medicare insurance (in green.)
You may have to contact more than one facility to find the right one for you. Ask about costs and how they help patients with dementia. If one seems like it may be a good fit, ask to tour the home to really get a feel for it.
Does Medicare Pay for Home Health Care for Dementia Patients?
In order for Medicare to cover hospice care, your doctor must first document that you have less than six months to live. You or your durable power of attorney must sign documents indicating that you agree to accept care for comfort, and that you waive other Medicare benefits.
Resources for Families
Families of dementia patients have access to a wide variety of resources to help them cope. The first step for helping your loved ones is to educate yourself about the disease and to learn how you can be the most supportive.
You should also look into support groups for your family so they can find like-minded people who are having similar experiences. Dementia should not be dealt with alone.
You should consider important things such as who will have the power of attorney and make financial decisions for the patient at the end of his or her life. If you haven’t enrolled in a life or a final expense insurance policy, you should consider doing so now.
We Can Help You Find Medicare Coverage for Dementia
Dementia is difficult for everyone involved. If you or a loved one has dementia, we can help you navigate Medicare dementia care and find a Chronic Special Needs Plan that’s right for you. Set up a no-obligation appointment with a licensed agent by calling 833-438-3676 or contacting us here today.
This post was originally published on May 7, 2019, and updated on October 7, 2019.
Get Middle Tennessee Dental Care with Medicare and Interfaith Dental
Nashville and Middle Tennessee residents don’t have to suffer from a lack of affordable dental coverage. In 1994, Dr. Tom Underwood founded Interfaith Dental with the help of the Nashville Dental Society and the Outreach Commission of West End United Methodist Church.
Interfaith Dental makes it possible for low-income families to access the dental care they need without having to pay full price.
Low Income Dental Clinics in Middle Tennessee
Middle Tennessee has quite a few public health clinics, and many specialize in dental care for low-income families and individuals. We work closely with Interfaith Dental, located both in the Fesslers Lane/Elm Hill Pike area of Nashville and near the St. Thomas Rutherford Hospital campus in Murfreesboro. Below are some of the low-income dental clinic options you have in Middle Tennessee.
Not located in Middle TN? That’s ok – there are plenty of low income dentists throughout the country. This government website is operated by the Bureau of Primary Health Care, a part of the Health Resources and Services Administration. You can use their tool to find a federally-funded community health center that offers dental services.
Interfaith Dental is a low income dental clinic with a mission to “create a healthier community by providing transformational oral health care for those experiencing poverty.” They envision a Middle Tennessee community where every resident “has the opportunity to achieve and sustain a healthy smile,” regardless of income status.
When it began in 1994, IFD only had two chairs and one employee, operating out of the West End United Methodist Church basement. By 1998, they were able to move their operation to 1721 Patterson Street (just off West End, near the St. Thomas Midtown campus).
In 2012, they opened another clinic in Murfreesboro, expanding their reach into Rutherford County. In even bigger news, this past year (2019), the clinic was able to expand into a new office at 600 Hill Avenue (near the Fesslers Lane/Elm Hill Pike intersection).
They’ve come along way from their two-chair operation, now owning 26 state-of-the-art dental operatories.
How to Become an Interfaith Dental Patient
Since the Interfaith Dental Clinic offers such low-cost dental care, there is an application process before you become eligible for services. To be eligible, you must be legally considered low-income (living below the poverty line), uninsured, and suffering from a devastating dental disease.
To get more information or to schedule your first appointment, call 615-329-4790 for the Nashville office, or 615-225-4141 for the Murfreesboro office.
Your Interfaith Dental journey will begin with a phone questionnaire. You’ll be asked for some basic information which will determine if you are eligible for Interfaith Dental Clinic services and what services you need.
Next, the Patient Care Coordinator that you speak with will tell you when the next “Application Day” is. On that day, you’ll come into the office to complete your application. Both the Nashville and Murfreesboro locations have the same office hours in 2019, which are:
Monday through Wednesday, 8 AM to 4 PM
Thursdays, 1 PM to 7:30 PM
Fridays, 8 AM to 12 PM
Be sure to bring the following items with you on “Application Day”:
Current Year Tax Return
Two current pay stubs for anyone working in your household.
If you are paid in cash, provide written documentation from your employer on a business letterhead that contains the business name, address, phone number, and owner information as well as your hire date, hours worked per week, pay rate, and hourly income.
College students, bring your class schedule
Work training program participants, bring proof of enrollment.
65+, provide social security/pension/retirement proof of income.
Proof of address (utility bill, bank statement, etc.)
TN driver license
Referral from medical professional, social worker, or employer (if you have one)
Due to high demand, there may be a waiting period for your services. There are a limited amount of applications that are handed out on a first-come, first-serve basis every month.
While walk-ins are generally not accepted, please call Interfaith Dental if you have a dental emergency. Some emergency services are offered on a first-come, first-serve basis.
What to Expect from Your First Interfaith Dental Appointment
At your first Interfaith Dental Clinic appointment, you’ll begin by meeting the team members. Then, someone will sit with you to review your medical and dental history and discuss all of your dental concerns.
Interfaith Dental care is comprehensive – they want to know how your dental health has affected your career, your family, and even your self-confidence. Is your goal to have a beautiful smile again, or to eliminate pain? Your care providers will hear all of your concerns and follow up with the best possible care.
The next step of your first appointment is a series of full diagnostic X-rays and oral exams that will help the doctors determine a treatment plan. Phase one will usually include fillings, cleanings, and extractions, and phase two will include crowns, root canals, and even partial dentures, if necessary.
If that sounds like a lot, it’s because it is. Your first appointment with Interfaith Dental can take up to two hours, in some cases – so be sure to allow that much time out of your day.
Medicare Dental Coverage in Middle Tennessee
Original Medicare only covers dental services when they are part of a hospital stay.
For example, if you go to the St. Thomas emergency room with a fractured jaw and need emergency dental care in the hospital, those services may be covered by Medicare Part A. However, common dental services and treatments such as annual exams, cleanings, root canals, dentures, implants, etc. are not covered by Original Medicare.
To get Medicare dental coverage, you’ll need to either enroll in a private, individual dental plan or a Medicare Advantage (Part C) plan. Medicare Advantage plans, even though they are Medicare health plans, are operated by private insurance companies, which allow them to add benefits that the Original Medicare program does not cover. This can include not only dental benefits but also benefits like fitness programs, vision, meal delivery, etc.
Medicare Plan Finder and Interfaith Dental, Bringing Change Together
Medicare Plan Finder works with Interfaith Dental by helping their patients fill the gaps in their dental coverage. Interfaith Dental is not always able to provide free or very low-cost care. For example, there may be times where a $10,000 dental procedure costs $5,000 at Interfaith Dental. You’d still be paying $5,000 less than if you went to a regular dentist, but that $5,000 may be more than you can handle. At Medicare Plan Finder, we try to match you up with a low-cost insurance plan that can cover those extra out-of-pocket costs.
Start by scheduling your appointment at the Interfaith Dental Clinic located nearest to you. Call 615-329-4790 for the Nashville office, or 615-225-4141 for the Murfreesboro office.
Then, if your doctor determines that you need a series of procedures that you can’t afford (even with Interfaith Dental’s help), give us a call at 833-438-3676. We can help you determine whether or not you are eligible for Medicare (did you know you don’t have to be 65?). If you’re eligible, we’ll help you find low-cost coverage so that you can go back to Interfaith Dental to get the services you need.
11 Crucial Tips for Taking Care of Elderly Parents at Home
Taking care of an elderly parent at home may be the most important thing you ever do, but it can be easy to get bogged down with the day-to-day struggles you may encounter.
You can help minimize your physical and financial stress that can come with caring for aging parents with some planning and resources. Follow these 11 tips to set yourself up for caregiving success.
1. Monitor Medications
One vital part of caregiving is making sure your parent receives his or her medications on time. Many pharmacies have apps that allow you to set up automatic refills for qualifying prescriptions, and you can even have prescriptions mailed directly to you.
It’s important to find a health insurance plan that will help pay for all of your parent’s medical needs. Medicare is a fantastic resource for paying medical expenses, but Original Medicare may not cover all of the services your loved one needs, such as prescription drugs.
You may have to look into private insurance policies called Medicare Supplements or Medicare Advantage plans to cover additional services and ensure that your parent’s insurance meets his or her needs.
If you need help paying for your parent’s medications, Medicare Part D or certain Medicare Advantage plans offer prescription drug coverage. There may be many plan options out there for you, and asking a qualified professional for help finding the right one may make the difference in your loved one receiving the right care.
2. Find Assistive Devices to Help Make Life Easier
As your parent ages, he or she may have difficulty performing actions such as bathing, standing up, or walking, and you may consider using assistive devices or Durable Medical Equipment (DME) to help make life easier. Assistive devices for the elderly range in supportive functions from fall prevention and mobility (canes, walkers, wheelchairs) to helping button shirts or clean.
Medicare Part B will help cover DME if your doctor prescribes the devices. You may owe deductibles or coinsurance. Some items such as wheelchair ramps and handrails may not be considered DME, but some Medicare Advantage plans cover those home modifications.
3. Hire Outside Help if Necessary
At some point, your parent may require more help than you can provide. You may have to enlist the help of skilled nurses or other healthcare professionals to perform the required level of care. If you don’t know where to start looking, your parent’s doctor may recommend a home healthcare service, or Medicare has a registry where you can find agencies in your area.
Some parents will need long-term care, and Medicare will not cover those services. You can, however, purchase long-term care insurance to help pay for expenses such as a full-time nurse.
4. Make Sure Your Loved one Stays Active
An active lifestyle that includes regular exercise may help prevent chronic diseases. Resistance training combined with cardiovascular exercise can help manage symptoms of osteoporosis, diabetes and chronic hypertension. Go on walks with your parent, go to the pool or look for fitness classes geared toward seniors such as Silver & Fit® or SilverSneakers® in your area. Certain Medicare Advantage plans cover fitness classes.
5. Find Proper Nutrition for Your Loved One
Ensuring that your parent eats properly can be time-consuming. You may be responsible for grocery shopping, meal preparation, and making sure your loved one eats at the right times throughout the day. Not only that, but your parent’s doctor or dietitian may recommend that your parent eats a certain number of calories or that your parent’s diet focuses on lean protein sources, fruits, and vegetables.
You can cut down on the time it takes for meal preparation by preparing meals for a few days in advance and putting them in single-serving containers. Look for recipes with simple cooking methods such as using a slow cooker or one-pan meals.
Some Medicare Advantage plans even cover meal delivery, which would dramatically cut down on the time you spend worrying about your parent’s nutrition.
6. Create a Schedule
Creating a schedule and sticking to it is extremely important when taking care of elderly parents at home. You’ve got a lot to do for yourself and your loved one, and if you don’t establish a routine for house cleaning, running errands, or bathing, then those things may not get done.
Take some time every week and make a list of everything you and your parent need to accomplish. Create a calendar that includes all of the events for the week because seeing doctor’s appointments, meal delivery times, etc. will help you coordinate everything your parent needs and also let you schedule some time for yourself.
7. Take Time to Care for Yourself, Too
It can be easy to forget about self-care when you’re so involved with your loved one, but taking some time for yourself is extremely important.
Find some time to relax. Take bubble baths, meditate, or do anything else that makes you happy. The important thing is that you feel refreshed and recharged when you go back to your parent.
Be active. Exercise is not only beneficial for your physical health, but also your mental health. The vast majority of people who exercise regularly report lower stress levels than sedentary individuals. Consider doing yoga, jogging, cycling or joining the gym where your parent takes fitness classes.
8. Find a Support System
Self-care may look like finding a support group or therapist so you can talk about how you feel. Your job as a caregiver may be overwhelming if you feel like you’re alone. If you can openly talk about what’s going on and get information on how to cope, you can provide better care because you’ll have better emotional health.
Sometimes you may just need a break, but you’re unable to leave your loved one alone.
Ask other family members to step in when you need some time off or it could be time to consider finding respite care services, which allow you to rest. Respite care may mean that your parent stays in a hospital temporarily or goes to adult day care.
You have rights as a caregiver. The Family Medical Leave Act (FMLA) allows employees who meet certain requirements to take up to 12 weeks per year off to care for qualifying immediate family members.
If your employer has 50 or more employees, you must be allowed to return to your original position or its equivalent when you return to work.
If your employer fires you or demotes you, or refuses to grant leave, you may have a case against your employer for FMLA violations and workplace discrimination.
Talk to an employment lawyer or to your to the Department of Labor if you think your rights have been violated.
10. Obtain Power of Attorney to Make Important Decisions
In order for Medicare to allow you make decisions for your parent, you must first have the right kind of power of attorney (POA). There are many different types of POA, but a Durable Power of Attorney is the only kind Medicare will accept, and it’s the most beneficial for taking care of elderly parents at home. A Durable Power of Attorney will allow you to make medical decisions for your parent before he or she becomes incapacitated.
11. Find Government Assistance for Caregivers of Elderly Parents
Taking care of elderly parents at home can be a full-time job. You may be able to find government assistance for caregivers of elderly parents and receive payment for your hard work. Medicare will not pay for you to provide caregiver services, however, Medicaid will in some states.
It may feel like you’re all alone, but there are some federal resources that can help ease your stress. The National Family Caregiver Support Program (NFCSP) provides a wealth of resources to caregivers information on where to find support groups, educational materials for specific conditions and contact information for advocacy organizations. You’ll be a better caregiver if you use the government resources available to you.
We Can Help You and Your Loved One Find Coverage for Home Care Services
The right insurance plan can help cover the cost of at-home care services. If you have power of attorney, a highly-trained licensed agent with Medicare Plan Finder may be able to help you find a plan that fits your budget and lifestyle needs. Call 844-431-1832 or contact us here to learn more.
How Medicare and Medicaid Work Together
Medicaid helps lower the cost of Medicare for more than 12 million dual-eligibles. In fact, Medicaid is the nation’s largest public health insurance program for people with low income and covers more than 1 in 5 Medicare enrollees. Are you eligible? Here is everything you need to know about Medicaid, Medicare, eligibility, costs, and savings programs.
What is the difference between Medicare and Medicaid?
Medicare and Medicaid can be easily confused, but they are two separate government-operated programs. Medicare is a federal program that provides health coverage for seniors over 65 and other Medicare-eligibles, regardless of your income. Medicaid is a state and federal program that provides health coverage for those with low income. However, if you are dual-eligible, you are eligible for both Medicare and Medicaid. This allows you to expand your network to include Medicaid doctors and decrease your out-of-pocket healthcare costs.
Those who are over 65 and those who receive SSDI (Social Security Disability Insurance) are eligible for Medicare.
Medicaid eligibility is different in every state and is largely based on income level. Though this varies by state and marital status, if you know that you are under the Federal Poverty Level, there’s a good chance that you qualify for Medicaid.
Can you Have Medicare and Medicaid?
If you are dual-eligible, that means you’re eligible for both Medicare and Medicaid. That can mean that you are both low-income and over 65, both low-income and on dialysis for ESRD, or any other qualifier listed below.
When you have both Medicare and Medicaid, Medicare will cover you first. Your Medicaid will serve as sort of a backup plan when you need more coverage than Medicare can provide.
People who are eligible for both Medicare and Medicaid may qualify for a Dual-Eligible Special Needs Plan, or DSNP. DSNPs often come with very low or $0 premiums, and Medicaid often covers the resounding copayments. DSNPs are not available in every area, and each plan can be a bit different, so be sure to ask your agent.
Dual-eligible beneficiaries are sometimes eligible for a Medicare Savings Program (MSP) as well. An MSP can help you pay for your Medicare premiums. You’ll also be enrolled in Extra Help, a program that helps you pay for your Medicare prescription drug costs. You may hear Extra Help referred to as LIS, or Low-Income Subsidies.
Bonus: if you are eligible for both Medicare and Medicaid, you have a Special Enrollment Period (SEP). That means that you don’t have to wait for the Annual Enrollment Period (AEP) to enroll or make changes to your plan.
Medicare and Medicare Eligibility Check
Ready to find out if you are eligible for Medicare? Do you fall into any of the below categories?
I am over the age of 65 or will be turning 65 within the next few months.
I have ESRD (End-Stage Renal Disease/Kidney Failure) and am receiving dialysis treatment.
I have Lou Gehrig’s disease (amyotrophic lateral sclerosis or ALS).
I have received Social Security Disability Income for over 24 months.
I receive retirement/disability income from the Railroad Retirement Board.
Note that to qualify, you also must be a U.S. citizen.
Medicaid eligibility is going to depend largely on what state you live in. While Medicare is more federally regulated, Medicaid is mainly state-regulated. For example (2018), in Tennessee, a family of four can qualify for Medicaid with an income of less than $32,718 annually. However, in New York, a family of four can only qualify for Medicaid with an income of less than $32,319.
Some of the groups that most commonly pass the Medicaid eligibility check are U.S. citizens like:
Those under 21 with low income
Pregnant women with low income
Low-income parents of minors
Low-income women undergoing breast or cervical cancer treatments
Those who receive Social Security benefits
Individuals who live in nursing homes or receive other long-term care and require financial assistance
If you think you are eligible, you can access the Medicaid Application for every state from the Healthcare Marketplace website.
Medicaid Doctors and Costs
A great way to find providers in your area who accept Medicaid is by using an online search tool like “DocSpot.” From DocSpot, you’ll enter your city, your type of coverage (Medicaid), and the type of doctor you are looking for. DocSpot will populate results for you where you can read reviews and pick Medicaid doctors in your area that you can schedule an appointment with.
If you have both Medicare and Medicaid, you can expand your doctor network to also include those who accept Medicare. If you have Medicare Advantage (a Medicare plan offered by private companies instead of the federal government), you’ll want to use your plan’s website to search for a provider that accepts your coverage.
Your Medicaid, Medicare, and Medicare Advantage costs will all depend on your financial status and the type of plan you select.
Medicaid Prescription Drug Costs
Technically, prescription drug coverage is an optional federal Medicaid benefit. Since Medicaid is a state-based program, all states determine their own prescription drug coverage. Currently, all U.S. states provide outpatient prescription drug coverage to eligible Medicaid beneficiaries. Depending on your state, you will receive either free or heavily discounted prescription drugs when receiving Medicaid benefits.
Additional Medicaid Costs
Some Medicaid beneficiaries will be required to pay copayments for certain services. It all depends on your income. For example, for non-institutional care (such as a doctor’s office visit), anyone at 100% of the federal poverty level will have to pay a copay of $4.00. Anyone whose income is 150% above the federal poverty level will have to pay 20% of the costs. Keep in mind that the federal poverty level can change every year and also takes into account the number of people living in your household.
Medicare Extra Help Application
If you have Medicare but do not qualify for Medicaid, fear not! You may still qualify for financial assistance in another form: Medicare Extra Help.
Medicare Extra Help, otherwise known as LIS (Low-Income Subsidies), helps you cover your prescription drug costs that Medicare does not cover. To qualify for Extra Help, you must first have Original Medicare (Part A and Part B). You cannot have savings, investments, and real estate that total more than $28,150 (or $14,100 if you are single).*
Even if you do not qualify for full Medicaid benefits or if you don’t qualify for Medicare Extra Help, you can still qualify for a Medicare Savings Program. There are four Medicare Savings Programs:
Qualified Medicare Beneficiary (QMB)
Pays for Medicare Part A and B premiums, deductibles, coinsurance, and copayments. Also makes you eligible for Medicare Extra Help. To qualify for QMB, you:
Cannot exceed individual monthly income limit of $1,032
Cannot exceed married monthly income limit of $1,392
Cannot exceed individual assets limit of $7,560
Cannot exceed married assets limit of $11,340
Specified Low-Income Beneficiary (SLMB)
Pays for Medicare Part B premiums. Also makes you eligible for Medicare Extra Help. To qualify for SLMB, you:
Cannot exceed individual monthly income limit of $1,234
Cannot exceed married monthly income limit of $1,666
Cannot exceed individual assets limit of $7,560
Cannot exceed married assets limit of $11,340
Qualifying Individual (QI)
Pays for Medicare Part B premiums. Also makes you eligible for Medicare Extra Help. To qualify for QI, you cannot have Medicaid and you:
Cannot exceed individual monthly income limit of $1,386
Cannot exceed married monthly income limit of $1,872
Cannot exceed individual assets limit of $7,560
Cannot exceed married assets limit of $11,340
Qualified Disabled & Working Individuals (QDWI)
Pays for the Medicare Part A premium if you are working, disabled, and under 65 OR if you lost your premium-free Part A when you went back to work. You must not be receiving state medical assistance. You also:
Cannot exceed individual monthly income limit of $4,132
Cannot exceed married monthly income limit of $5,572
Think you are eligible for Medicaid? You can apply either online through the Health Insurance Marketplace or through your state Medicaid agency. To use the Health Insurance Marketplace Medicaid Application, click here.
Each state has its own Medicaid Application on its own Medicaid website. It may be a good idea to meet with an agent first so that you can get help with your application.
Are you eligible for Medicare and Medicaid?
If you’re not sure whether or not you are eligible for Medicare and Medicaid, we can help. Give us a call and we’ll ask you a series of questions to help you find out if you’re eligible.
If you are eligible, we can send an agent to your home to help you sort through your health care options. Another perk of being eligible for both Medicare and Medicaid is that you can receive a Special Enrollment Period, meaning that you can make changes to your coverage during any time of the year and don’t have to wait for the Annual Enrollment Period in the fall.
Our agents are licensed to sell plans from multiple different carriers, so they can help you pick the plan that truly works best for you.
To get started, give us a call at 1-833-438-3676 or click here.
This post was originally published on March 15, 2018, and was updated on September 28, 2018, and updated again on April 3, 2019.
The Medicaid Look Back Period: What You Need to Know
What is the Medicaid look back period?
Medicaid is designed to provide health care to those with low income or limited assets and is administered through each state. When applying for Medicaid, the state social security office is responsible for confirming you have limited income and assets. The Medicaid look back period is a period of time the office will review to see if you sold, donated, transferred, or gifted any of your assets. The period is 5 years for every state except California where it is 2.5 years. This period starts on the date you apply for Medicaid.
Is there a penalty?
Yes, there is! If the social security agency finds that you sold, donated, transferred, or gifted any of your assets beyond the granted exemptions, you will have a penalty. The penalty is a length of time that you will be ineligible for Medicaid. This is called the penalty period, and there is no limit on the amount of time you can be penalized for.
The penalty is based on the dollar amount of sold, donated, transferred, or gifted assets divided by the monthly private patient rate of care in a nursing home. For example, if you gifted $60,000 during the look back period and the average monthly cost of nursing home care is $4,000, your penalty would be 15 months of Medicaid ineligibility ($60,000 gift/$4,000 average month cost = 15 months).
Can you avoid the penalty?
Planning is key in an attempt to avoid the penalty. Did you know you can gift up to $15,000 a year without paying a gift tax? This is a great option if you’re wanting to leave a certain amount of your savings to a child or loved one. If you want to gift $60,000 it will take 4 years to avoid taxation. This means that you would need to start gifting 9 years before applying for Medicaid to avoid the look back penalty.
Are there exemptions?
Fortunately, there are exceptions that allow applicants to transfer assets without a penalty. The exceptions include:
Medicaid applicants can transfer a certain amount of their assets to their spouse. The spouse cannot be in the Medicaid application process and must plan to live independently in the community. The total amount of assets able to be transferred will change annually, but in 2018 the limit is $123,600.
Applicants can transfer their assets or establish trust funds for disabled children who are under the age of 21, including children who are legally blind.
A home can be transferred to a sibling who has equity in the home and resided in the home for a minimum of one year prior to a nursing home placement.
Applicants can transfer their home to their adult children if they lived in the home for a minimum of two years before the Medicaid application was started. The child must be the primary caregiver.
Applicants can pay off their debt without a penalty.
If you’re interested in learning more Medicaid information that is specific to your state, visit our Medicaid by State page. Plus, you may be eligible for both Medicare and Medicaid! Our licensed agents can help answer any questions you may have and help you sort through your health care options. To get started, fill out this form or call us at 833-438-3676.