Does Medicaid eligibility change Medicare choices?

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Does Medicaid eligibility change Medicare choices?

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My 89-year-old dad will be soon spending the last of his savings. He rents, so other than his car will have no assets. I think that makes him Medicaid eligible. How does being on Medicaid change what he should be doing with his various Medicare parts like prescription and medigap?

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Does Dad have a Medicare Advantage or traditional Medicare. Makes a difference.

If Dad has traditional Medicare he is paying out of pocket for his prescription and Medigap insurances. Medicare does not cover these. So when he goes on Medicaid he will keep his Medicare and Medicaid will take the place of his prescription and Medigap coverage. When Dad goes on Medicaid, his SS and any pension will go to his care and then Medicaid pays their share. I understand that some states require you keep your present supplements but the cost of those premiums get deducted from his SS.

Medicare Advantages are a whole different thing. Medicare contracts with them. That means that the MA plan oversees the Part A & B of Medicare and offers prescriptions, supplemental, vision and dental. How this works when Medicaid gets involved I have no idea. May mean reverting back to Traditional Medicare and then Medicaid is the supplemental. Maybe someone on the forum can answer that. Or call your Social Service Office and ask for a Medicaid caseworker to run that question by them if he has a MA plan.

If Dad has no assets, he will not be able to go to an Assisted Living or independent living. Medicaid does not pay for these. Independent living definitely not. Assisted living is usually private pay but some states offer Medicaid waivers. The only thing Medicaid definitely pays for is Long-term care. Usually those Communities that offer IL, AL, and LTC you buy into. And still are required to pay rent. Only the LTC excepts Medicaid.

Dad has to fit the criteria of LTC. He must need 24/7 care for Medicaid to pay. Dementia counts here.

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If he is fully functioning then he is not Medicaid eligable. He either qualifies for a nursing home if he has 3 or more issues with daily issues such as bathing, dressing or cooking, If he wants in home care, they will send an aid over for a few hours each week to help with bathing but they will not cook or clean after him depending on an aid's scope of practice.
If this is going to become a homelessness situation, you need to contact your APS ASAP. There sometimes is housing available but there can be wait lists for months or years.

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Medicaid is a financial needs based program at any age. Has nothing to do with his functioning level. As other response says, no need for medigap and part D once he has Medicaid. It could take a couple months to get application approved so start a little before all the money is gone (so we've been told). Depending on state, you can have up to a certain amount in resources, like maybe $12k and still qualify.

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People can be eligible for Medicaid and be "fully functioning", in the community. What comes up most often on this site is becoming eligible for Medicaid when the need for care in a nursing home is necessary. That is not what the OP brought up. Original Medicare and Medicaid can go together without the need for a prescription plan, or a Medicare Advantage or Supplemental plan. This is referred to as being dual eligible. The state may cover the cost of the Medicare premium. That is dependent not only on the person's level of assets but v their minthly income. That is cheaper for the state to have the person have federal Medicare coverage than to shoulder all the costs on state Medicaid. After getting Medicaid there would be no reason to have the other plans he is paying for now.

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Yes. When someone has both Medicare and Medicaid they are considered ‘Dual Eligible.’ Depending on where you live, your dad may be eligible for a type of Medicare Advantage plan called a D-SNP, or Dual Eligible Special Needs Plan. D-SNP plans combine or coordinate Medicare and Medicaid benefits and often have no out of pocket costs for drugs and medical services. Also, they can have other supplemental benefits like dental care and often times a card to use for food.

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Every state is so different. Try your states Pace office or social services for your answers! My mom goes broke in 18 months {91 yr old}…$300,000 gone for assisted care over 5 years..so sad in the USA we get bled dry in such a short period of time…I will head to social services and begin my chat..

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I totally agree. People have worked hard all there lives and saved for there golden years and then something happens to you and the government wants all your money before there willing to help, plus if you didn’t do something with your assets at least five years prior to you needing help the government will make you sell it or put Lien’s on stuff so if you try to sell they get the money first. Like you said when you need full time care it’s gone in no time and then I can’t believe it’s cheaper to put someone in a nursing home than pay for in home care. It cost my mom $8,000.00 a month for the nursing home and it would have cost around $20,000.00 a month to have in home care 24/7. Plus you would think since you have to have medicare it should take care of some nursing home or in home care. It just amazes me that we can give trillions of dollars to Ukrainian and let illegals in and give them food stamps and Medicaid but the people here in the US can’t get help and definitely not for free. Even on hospice you still have to pay for your room in the nursing home but yet they want to take people off Medicaid. Our country is awful when it comes to how we have to pay for our own healthcare out of our pocket and other countries take care of there people.

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Your dad needs to apply at his state's social service, or Medicaid office for QMB Medicaid. It really depends on the state he lives in as to how much assistance he can get. My state is very generous, as even those with an income up to around $2700 ( the exact figure is within $100 of that) a month receives some benefits. The less income from SS you receive, the more you can get in benefits. There are 3 or4 different tiers or levels and as your income falls below each tier, you get more assistance with prescriptions, copays, etc. He may not even need to buy a Medigap plan. You need to research the income levels in his state, and I would also meet in person with a state worker and apply.

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Verify dual Medicare and Medicaid plans where your father lives. If he cannot afford to pay his monthly traditional $165.80 Medicare Part B premiums, Medicaid can pay back partial or entire expenses back to his Social Security benefits. It is the law to have Medicare Part B, alone or with Medicare Advantage or MediGap. Dropping these benefits and later claiming them means having to pay an additional 10 percent penalty with regular premiums for life.

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You can have Medicare and Medicaid together and it sounds like dad is eligible.
Get in touch with Social Security, call your local office. It is much easier to talk to the local office than the national toll free number. If you have a rural office in the vicinity call them.

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If your family member is Medicaid eligible. You should call his local State Medicaid Agency and get him enrolled. If he qualifies; It will allow him to get the proper medical and prescription drug coverage. Also possibility of in home care. It might improve his overall financial health as well!

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My brother was on Medicaid when he was eligible for Medicare. Nothing changed. I had him on a Medicare supplement as well. Medicaid picked up the co-pays from Medicare. The supplement was a lifesaver when he had surgery and hospitalization out of state since Indiana Medicaid didn't cover out of state treatment. I'm not familiar with the prescription info since he was in hospice when he was receiving meds. In Indiana he was able to have a Medicaid waiver that paid the balance of his AL facility. Each state has it's own Medicaid rules so do your research.

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Assuming he has social security income (and maybe retirement), he will stay on his social security with Medicare and whatever he uses for Rx drugs. Commonly, social security income is more than SSI income, so you just stay on the Social Security with Medicare. I think the SSI pay for 2023 is $914 (and some states add a little to that amount). If he gets social security and it's less than $914, you should call SSA and ask about his eligibility for SSI so they can at least get him to that $914 level of pay. If he already gets more than that from social security, then he stays with that.

Should he need a nursing home, you won't have to worry about his savings account being over the limit (in Texas it's $2000). His income, however, maybe over the limit. If his income is enough to pay for NH care, no problem. If is income is not quite enough to pay NH, he would apply for Medicaid to cover the difference between his income and charge for the NH bed.

There are some Medicaid associated programs that you can apply for to assist with things for home care or maybe pay his Medicare premiums. You should be able to apply for them to see what he's eligible for online. Check out Medicaid where you live (online or at a local office)

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Wilsteve58: Perhaps you should seek the assistance of an insurance agent.

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Does Medicaid eligibility change Medicare choices?

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