When you reach age 65, your Medicaid coverage may change. In most states, you’ll be automatically enrolled into Medicare, which is a federal health insurance program for people aged 65 and older. Medicare has two parts: Part A, which covers hospital care, and Part B, which covers doctor visits, outpatient care, and some medical supplies. If you have a low income and limited assets, you may also qualify for Part D, which helps cover prescription drug costs. Depending on your state and income, you may be able to keep your Medicaid coverage even after you turn 65. You may be eligible for a Medicare Savings Program, which helps pay for Medicare premiums, deductibles, and copayments. Or, you may be eligible for dual eligibility, which means you have both Medicare and Medicaid coverage.
Medicaid Coverage and Changes at Age 65
As you approach the age of 65, you may wonder how your Medicaid coverage might change. Here’s a detailed explanation of what to expect regarding your Medicaid eligibility and options at age 65 and beyond:
Automatic Change to Medicare
When you turn 65, you will automatically be enrolled in Original Medicare (Medicare Part A and Part B). This is true even if you are already receiving Medicaid. Medicare will become your primary health insurance, and Medicaid will become secondary.
Medicaid Spend-down Program
Some states offer a Medicaid Spend-down Program. This program allows individuals with income and assets that exceed the Medicaid eligibility limits to still qualify for Medicaid coverage, as long as they spend down their monthly income and assets to the required limits.
Spend-down Process
- Calculate your monthly income and assets.
- Subtract certain allowable expenses from your income, such as medical bills, Medicare premiums, and nursing home costs.
- The remaining amount is your spend-down amount.
- You must spend down your income and assets to this amount each month in order to qualify for Medicaid coverage.
Other Medicaid Options at Age 65
In addition to the Medicaid Spend-down Program, there are several other Medicaid options available to individuals age 65 and older, including:
- Medicaid Long-Term Care Programs: These programs provide coverage for long-term care services, such as nursing home care and home health care.
- Medicare Savings Programs: These programs can help you pay for Medicare premiums, deductibles, and copayments.
- Extra Help Program: This program can help you pay for Medicare Part D prescription drug coverage.
Additional Information
For more information about your Medicaid coverage options and to learn how to qualify for Medicaid, you can contact your local Medicaid office or visit the Medicaid website.
| Income | Assets | Eligibility |
|---|---|---|
| < $1,359/month | < $2,000 | Qualify for full Medicaid |
| $1,359-$1,731/month | $2,000-$22,850 | May qualify for Medicaid with a spend-down |
| > $1,731/month | > $22,850 | Not eligible for Medicaid |
Medicaid and Turning 65
Turning 65 brings changes to your health care coverage. Here’s what happens to your Medicaid coverage when you reach this milestone:
- Continuing Medicaid Coverage: If you meet certain criteria, you may be able to keep your Medicaid coverage after turning 65.
- Transitioning to Medicare: For those who qualify, Medicare will become your primary health insurance coverage, with Medicaid acting as a supplemental plan.
- Applying for Medicaid: If you’re not eligible to keep Medicaid automatically, you can apply through the regular process.
Medicaid Waiver Programs
Medicaid waiver programs offer additional options for long-term care and home-based services.
- Eligibility: These programs have specific eligibility requirements.
- Benefits: They cover a range of services, including nursing home care, home health care, and personal care services.
- Examples: State-specific waiver programs include Home and Community-Based Services (HCBS) and Program of All-Inclusive Care for the Elderly (PACE).
| Coverage | Medicaid | Medicare |
|---|---|---|
| Eligibility | Based on income and resources | Available to those aged 65 and over, or those with certain disabilities |
| Benefits | Covers a wide range of medical services | Covers hospital stays, medical services, and prescription drugs |
| Costs | Premiums, copayments, and deductibles may apply | Premiums, copayments, and deductibles vary depending on the type of Medicare coverage |
Remember, Medicaid coverage varies by state. It’s crucial to contact your local Medicaid office or visit the official Medicaid website for detailed information.
Changes to Medicaid and Medicare Coverage at Age 65
Turning 65 typically brings several changes to your healthcare coverage through Medicaid and Medicare. Understanding these changes can help you plan for potential impacts on your healthcare and finances.
Medicare Part D Extra Help Program
The Medicare Part D Extra Help Program provides financial assistance to people with limited income and resources to help cover the costs of prescription drugs. To qualify, you must:
- Be enrolled in Medicare Part A and/or Part B
- Have an income below certain limits (generally 150% of the Federal Poverty Level)
- Have assets below certain limits (excluding your home and vehicle)
If you qualify, you can receive help paying for your prescription drugs in several ways:
- Premium Assistance: Helps pay the monthly premium for your Medicare Part D drug plan.
- Deductible Assistance: Helps cover the yearly deductible for your Medicare Part D drug plan.
- Copayment Assistance: Helps pay copayments or coinsurance costs for your prescription drugs.
Other Changes to Medicaid and Medicare Coverage at Age 65
In addition to the Medicare Part D Extra Help Program, you may also experience the following changes to your Medicaid and Medicare coverage at age 65:
- Medicare coverage begins: Medicare Part A (hospital insurance) and Part B (medical insurance) generally start automatically at age 65 if you are eligible.
- Medicaid coverage may change: Your Medicaid coverage may change when you become eligible for Medicare. This may depend on your state, income, and specific circumstances.
- Costs may increase: Your out-of-pocket costs for healthcare may increase, such as premiums, deductibles, and copayments. It’s important to plan for these expenses.
- Coordination of benefits: Medicare and Medicaid will coordinate their benefits to ensure that you receive the appropriate coverage.
Table Summarizing Changes at Age 65
| Age | Coverage | Changes |
|---|---|---|
| Before 65 | Medicaid | Full coverage for eligible individuals |
| 65 and over | Medicare Part A and B | Medicare coverage begins automatically if eligible |
| 65 and over | Medicaid | Coverage may change or end, depending on state, income, and circumstances |
| 65 and over | Medicare Part D | Voluntary prescription drug coverage available |
Conclusion
Turning 65 can bring about significant changes to your healthcare coverage through Medicaid and Medicare. It’s important to understand these changes and plan accordingly to ensure you have adequate coverage and manage any potential increases in out-of-pocket costs.
When You Turn 65, What Happens to Your Medicaid?
When you reach the age of 65, you become eligible for Medicare, a government health insurance program. However, if you have Medicaid, a government health insurance program for low-income individuals, you may wonder what happens to your coverage when you turn 65. Will you automatically lose your Medicaid coverage? Will you be able to keep both Medicare and Medicaid? The answers to these questions depend on your specific situation.
Medicare Savings Program
The Medicare Savings Program (MSP) is a federal program that helps people with limited income and resources pay for Medicare premiums, deductibles, and coinsurance. MSP is available to people eligible for Medicare Part A (hospital insurance) and Part B (medical insurance). There are two types of MSP: the Qualified Medicare Beneficiary (QMB) program and the Specified Low-Income Medicare Beneficiary (SLMB) program. QMB is for people with income and resources below certain limits. SLMB is for people with income and resources slightly higher than QMB limits.
Qualifying for MSP
- To qualify for MSP, you must meet the following requirements:
- Be a U.S. citizen or permanent resident.
- Be age 65 or older.
- Be enrolled in Medicare Part A and Part B.
- Have income and resources below certain limits.
Benefits of MSP
- If you qualify for MSP, you may receive the following benefits:
- Help paying your Medicare Part A and Part B premiums.
- Help paying your Medicare deductibles and coinsurance.
- Help paying for Medicare prescription drug coverage.
Applying for MSP
To apply for MSP, you can contact your state Medicaid office or the Social Security Administration. You will need to provide documentation of your income and resources. Once your application is processed, you will be notified of your eligibility for MSP.
What Happens if I Qualify for MSP?
If you qualify for MSP, you will be able to keep your Medicaid coverage. However, your Medicaid coverage will be secondary to your Medicare coverage. This means that Medicare will pay for your medical expenses first, and Medicaid will pay for any remaining costs.
What Happens if I Don’t Qualify for MSP?
If you do not qualify for MSP, you may lose your Medicaid coverage when you turn 65. However, you may be able to purchase a Medicare supplemental insurance policy to help pay for your medical expenses. Medicare supplemental insurance policies are available from private insurance companies.
| Income Limits for MSP | QMB | SLMB |
|---|---|---|
| Individual | $1,513 per month | $1,809 per month |
| Couple | $2,041 per month | $2,428 per month |
That’s all there is to know about what happens when you turn 65 and have a Medicaid policy. I hope it wasn’t too confusing; I tried to make it as simple as I could. If you have any other questions, feel free to ask in the comments below. And thanks for reading! Be sure to visit again later for more helpful articles like this one.