If you have an older relative or friend without health insurance, you might wonder if Medicaid could meet her need for coverage. Going without health insurance is risky, especially in advanced age. One trip to the emergency room can cost thousands of dollars, and prescription drugs can cost hundreds of dollars a month. If she is not eligible for Medicare, does your aging loved one qualify for Medicaid?
Many people mistakenly believe that everyone gets Medicare, when they turn 65. This assumption is incorrect. You must have worked for enough years at jobs that earned enough money and paid into the Social Security system to get Medicare, when you hit 65. Medicare is an insurance system that receives part of its funding from the payroll deductions employers withhold from workers’ wages and that employers also pay in matching contributions.
Medicaid is a Safety Net
If a senior did not work enough years at jobs that paid Social Security taxes or worked only part-time, he might not qualify for Medicare. Let’s say he is self-employed as a house painter, but he barely made enough money to survive. His Social Security and Medicare payments through the years were not enough to make him eligible for Medicare, so he has “slipped through the cracks.” Far more Americans are in this situation than people might realize.
As a matter of public policy, we do not want people to be destitute at any age. Medicaid is the safety net that can provide needed medical care for seniors, who cannot afford health insurance and do not qualify for Medicare. Sometimes, Medicaid will pay for a senior’s Medicare premiums, deductibles, and coinsurance.
How to Qualify for Medicaid
Federal law requires states to provide Medicaid health insurance for people in certain categories, including low income. States use a person’s Modified Adjusted Gross Income (MAGI) to determine Medicaid eligibility. The maximum qualifying MAGI can change every year. People who are blind, disabled, or age 65 and older use the income guidelines of the Supplemental Security Income (SSI) program to qualify for Medicaid, instead of MAGI.
The SSI guidelines include both income and asset limits. If you earn $1,820 a month or more in 2018, you will not be eligible for Medicaid, but not everything counts as income.
An individual can own no more than $2,000 in assets ($3,000 for a couple), but Medicaid exempts assets from this total. Exempt assets include such things as your home and land if you live in the house, your household goods and personal items and the vehicle that transports you.
Your state’s Medicaid program might have different requirements, but they cannot provide less than the federal law requires. Your state might provide better Medicaid benefits or use more lenient qualifying criteria than the federal law. The MAGI income eligibility for Medicaid comes from the Affordable Care Act (ACA), which could change at any time due to changes in politics.
Medicaid regulations and benefits are different in every state, and can vary from the general law of this article. Talk with a local elder law attorney, to discover how Medicaid works in your state.
Centers for Medicare & Medicaid. “Eligibility.” (accessed September 6, 2018) https://www.medicaid.gov/medicaid/eligibility/index.html
Social Security Administration. “Understanding Supplemental Security Income SSI Eligibility Requirements – 2018 Edition.” (accessed September 6, 2018) https://www.ssa.gov/ssi/text-eligibility-ussi.htm