This article contains important facts about Medicaid as they pertain to those born between the years of 1946 and 1964 – the Baby Boomer generation.
Medicaid is the U.S. government-operated insurance program designed to cover health care expenses for low-income Americans including many baby boomers. One unique benefit of this government program is that Medicaid offers long-term coverage for many Americans who can’t otherwise afford these often necessary and expensive types of health care expenditures.
Seniors who are likely living on a fixed income need to understand the benefits of Medicaid and what it can offer them in terms of medical coverage. Being prepared for a medical emergency or ongoing care provides peace of mind when you need it the most.
Below are some facts that every baby boomer should know about Medicaid.
1. If you earn less than $17,774 in annual income as a single adult, then you qualify for Medicaid based on income requirements.
This income limit applies to all but 12 states as of August 2021. In states without expanded Medicaid, the income threshold is lower. Currently, there are 12 states that have not expanded Medicaid eligibility.
As of August 2021, the states of Georgia, Florida, Mississippi, Kansas, North Carolina, Wisconsin, South Dakota, Wyoming, Tennessee, Alabama, Texas, and South Carolina fall into this category. Check these states’ Medicaid requirements to view changes and the current status regarding income eligibility. Changes are on the horizon.
A discussion pertaining to the asset threshold to qualify is complicated since many assets that are normally accounted for on a balance sheet are excluded for the purpose of qualifying for Medicaid. It makes sense to consult with a trusted Medicaid counselor who understands all the specific rules and regulations that can differ by state.
2. KFF reports that Medicaid pays for 1 in 5 Americans’ healthcare expenses.
This government-funded program is designed to help people who can’t afford healthcare due to the high costs of health insurance and other roadblocks Americans face when accessing adequate medical care. A large number of seniors, in particular, rely on Medicaid. As a major source of critical long-term care support, Medicaid often picks up the bill for services not covered by Medicare and insurance companies.
3. Medicaid is largely spent on taking care of the elderly and disabled population.
While this program was designed with all people in mind regardless of age, seniors and people suffering from disabilities account for two-thirds of expenditures. Since acute and long-term care are both services required disproportionately by seniors and the disabled, Medicaid plays an enormous role in stabilizing these vulnerable populations of Americans.
4. Baby Boomers who qualify should sign up for both Medicare and Medicaid.
Medicaid.gov reports that 7.2 million low-income seniors are enrolled in both Medicare and Medicaid. Federal law states that seniors enrolled in both programs are eligible to be covered for mandatory and optional categories.
Since Medicare recipients often find themselves owing substantial medical bills related to services not covered by that program, enrollees who qualify for Medicaid can use that program as a supplemental resource. Common expenses paid in this type of situation are prescription drugs, continued skilled nursing care beyond the Medicare 100-day limit, eyeglasses, and hearing aids.
In situations where a medical cost is covered by both Medicare and Medicaid, then Medicare pays first. Medicaid then covers any cost remaining. Seniors on a fixed income stand to benefit from having this type of comprehensive coverage from both government programs.
5. Medicaid coverage varies in each state.
One of the reasons seniors are so confused by Medicaid coverage and eligibility is because it varies significantly by state. Granted, most disabled, low-income adults, in particular, are covered, but each state determines the guidelines used to determine eligibility for other groups. For example, many states extend coverage to people who otherwise earn more than they should based on Medicaid income requirements but who spend most of it on long-term care expenses.
Fortunately, there are some regulated benefits that must be paid by state Medicaid programs without exception. Both inpatient and outpatient hospital expenses must be covered. Other services such as lab services, x-rays, physician services, home health care, nursing home care, and rural clinic services are also paid by Medicaid as dictated by the federal government.
States are on their own to decide about whether they will pay for other health care services that many enrollees need. Optional services paid on a state-by-state basis are prescription drugs, personal care, dental and vision services.
6. Medicaid goes by a lot of different names, depending on the state.
As if Medicaid is not confusing enough already, many states use different names for their version of Medicaid. That’s why research is sometimes difficult to understand for those unaware of this fact. For example, Medi-Cal refers to California’s Medicaid program. Wisconsin named its program BadgerCare Plus. For something so serious, these cute names surprise many boomers at first glance.
7. Each state provides free counseling to help Medicare enrollees determine what Medicaid benefits are available to them.
Search State Health Insurance Assistance (SHIP) to obtain information and counseling services. Sadly, many people suffer financially because they aren’t aware of all of the services available to them. Qualified counselors can examine your personal information and help you navigate the maze that defines Medicaid and Medicare benefits and how they work together to provide comprehensive care for those eligible.
8. Medicaid has become a political football in some states.
The health of the Medicaid program and who is eligible are always on the ballot. The 12 states who refuse to expand Medicaid to serve their constituents, who overwhelmingly want it, appear to be playing games with people’s lives as a way to make a political point. NPR reports that this stalemate leaves about 2 million people who could be served by Medicaid in a political limbo of sorts, uncovered and unheard.
That’s why seniors and all voters have a vested interest in following the politics related to Medicaid and voting accordingly.
Medicaid enjoys enormous popularity as a program designed to address the needs of many Americans. Due to the confusion that is common surrounding eligibility for Medicaid and how it can work together with Medicare, reaching out to counselors is highly recommended. When in doubt, baby boomers should strive to receive every benefit available to achieve a stable and satisfying life, free from financial worries related to medical expenses