How Medicaid Can Help with Medical Expenses for Seniors

Larry’s elderly father is struggling to make ends meet. After moving into a senior apartment complex after the death of his wife and living largely off of his Social Security income, his father’s finances are tight. Larry is helping to find ways to pay the monthly rental fee, buy groceries, and cover co-pays for his heart medications and his Medicare coverage. His father needs assistance beyond Medicare to cover his growing medical expenses, and Larry has heard about Medicaid, but he’s not sure where or how to find out if his father is eligible.

His father’s situation is faced by many seniors; the Kaiser Family Foundation reports that one in four Medicare beneficiaries spent 30% or more of their income on health expenses in 2006. Making sense of Medicaid can be difficult for seniors and their caregivers. In the midst of an already confusing time, family caregivers often find confusion in the midst of Medicaid forms and filings. However, there are resources available to navigate Medicaid.

Medicaid and Medicare: The Basics

Family caregivers may think of Medicaid as solely paying for long-term care, especially after most other financial resources have been extinguished. If a loved one qualifies financially for Medicaid and meets the functional eligibility requirements, then Medicaid will help pay for long-term care services like nursing home care, and home and community-based services like home health care. However, Medicaid can also help low-income seniors with out-of-pocket medical expenses, and in some cases, Medicare premiums, co-payments, and deductibles. Medicare is a healthcare insurance program open to all seniors ages 65 and older. Some parts of Medicare, like Part A, are paid for through taxes that most people have already paid, while coverage for part B and part D will require paying monthly premiums. Part C, otherwise known as Medicare Advantage plans, will pay for Part A and Part B, and many cover Part D (drug coverage). For seniors who are struggling with high medical expenses, it can be worth checking out the resources below.

The Area Agency on Aging in your area is a good first stop to learn more about the process for applying for Medicaid. To find your local agency, you can look on the National Association of Area Agencies on Aging website, which lists agencies alphabetically by state.

The Medicare State Health Insurance Counseling and Assistance Programs (SHIPs), are another excellent resource, especially if you have Medicare questions, and are located in each state. To find the program in your state, visit the official U.S. Government site for Medicare, select your state from the drop-down menu, and click the first box that says “General Medicare Information.” On the next screen, scroll down and you should see contact information for your state’s State Health Insurance Counseling and Assistance Program. These counselors can help with choosing your Medicare coverage and plans.

Qualifying for Medicaid

While there are federal minimums and maximums, states have some flexibility in setting their financial eligibility rules for Medicaid. Fortunately there has also been some shift in recognizing that if one person in a couple needs Medicaid-funded assistance, it doesn’t mean that both members of the couple should have to spend down all of their assets. This protection is known as spousal impoverishment protection, and it is worth inquiring about if it applies in your situation. To apply for Medicaid, or to help a parent apply for Medicaid, you will need your loved one’s financial records, including bank statements and records of any investments or annuities. When you apply for Medicaid, there is also a five-year “look back” at any transfers of financial resources. If money has been transferred, the state may not pay long-term care expenses for a certain amount of time. Therefore, if a family member is being paid by a parent for caregiving, they should clearly document this with a contract. Otherwise, it may appear that a parent is merely giving money to a child so that the parent qualifies for Medicaid.

Look for Programs Under Different Names

Depending on the specifics of the situation, and the type of Medicare that your parent has, there are several different types of Medicaid and Medicare programs that may be helpful with paying for out-of-pocket costs, as well as Medicare premium costs. A guide produced by the Centers for Medicare and Medicaid Services, Dual Eligible Beneficiaries Under Medicare and Medicaid, lists the various programs. Don’t be afraid to ask about all of the different Medicaid services available to seniors in your state. While Medicaid is not available to all seniors, it may provide relief from burdensome medical expenses for impoverished seniors who are struggling to make end meet.

Additional Resources

Medicaid.gov: Seniors and Medicare and Medicaid Enrollees

AARP Public Policy Institute: Medicaid: A Program of Last Resort for People Who Need Long-Term Services and Supports