How Medicaid programs can help seniors pay for medical expenses

If you’re like many seniors, you may be living on a limited income. You might also be getting your health care through Medicare. Medicare typically has costs associated with it, meaning you must stretch your dollars even further, which can be challenging. But Medicaid may be able to help.

Unlike Medicare, where eligibility is based primarily on age, Medicaid eligibility depends on income level. If you qualify for Medicaid, and you’re dually eligible for both Medicare and Medicaid, Medicaid can help you with medical expenses beyond what Medicare typically covers.

Medicaid programs differ by state. Learn more, including if you’re eligible, which programs might be most helpful in your situation, what Medicaid can cover and how to help loved ones get the coverage they need.

Is Medicaid available for seniors?

Unlike Medicare, Medicaid doesn’t have an age requirement. Instead, eligibility is based on income, resource limits and other things. So, anyone of any age who may be eligible can apply, including seniors.

Medicare is broken into four parts (Medicare Parts A, B, C and D) where you may pay premiums, deductibles and copays, which can be difficult for seniors living on a limited income. That’s why Medicaid is especially helpful for older adults, because while Medicare provides basic health coverage, Medicaid is medical assistance that pays for things Medicare doesn’t.

If you don’t qualify for Medicaid as a senior, you may be eligible for a Medicare savings program or for help paying your Medicare costs. This includes assistance with paying your Part B premium or a Part D prescription drug plan, and more.

Which Medicaid benefits can help seniors

There are a lot of things Medicare covers, and a lot it doesn’t. Medicaid can fill in the gaps, and it can be low-cost or free for seniors. Benefits include:

1. Help with paying out-of-pocket medical expenses like copays, premiums, deductibles and other costs associated with Medicare Advantage plans
2. Coverage for additional services beyond those provided under Medicare such as nursing facility care beyond the 100-day limit of each benefit period, and coverage for vision, hearing, and prescription medications
3. Paying for senior services like in-home health care, or paying a spouse or relative to be a caregiver

What Medicaid covers for seniors

There are differences between what Medicare and Medicaid cover. While Medicare does provide basic coverage for things like hospitalizations and doctor visits, there are gaps in that coverage. Medicaid can step in to provide broader access to medical care and support services to seniors.

Though Medicaid is administered by each individual state, there are general federal guidelines each state program must follow. Each state must cover mandatory services that benefit all ages, but here we’ll focus on the ones that support seniors, including:

• Home health services
• Inpatient and outpatient hospital services
• Lab and X-ray services
• Long-term treatment facility stays, like in a nursing home
• Medication-assisted treatment
• Physician services
• Rural health clinic services
• Transportation to medical care

In Minnesota, Medicaid is called Medical Assistance, and it provides everything listed above, plus the following (among others) that may be important to seniors:

• Chiropractic care
• Dental services
• Doctor and clinic visits
• Emergency room (ER) care
• Hearing aids
• Home care
• Hospice care
• Immunizations and vaccines
• Interpreter services
• Medical equipment and supplies
• Medical transportation, both emergency and non-emergency
• Mental and behavioral health services
• Nursing home care
• Optical care
• Outpatient surgery
• Rehabilitative therapy
• Some prescription medication coverage
• Telemedicine services
• Urgent care

Dual eligibility at age 65

When you turn 65, you don’t need to choose between programs if you qualify for both. You can choose a Dual Eligible Special Needs Plan (D-SNP). These plans are offered through private health care companies, and they coordinate the benefits of both Medicare and Medicaid to maximize your care.

Advantages of D-SNPs include lower costs for coverage, care coordination to help you keep your plan straight and additional benefits you wouldn’t receive through Medicare alone.

In Minnesota, a D-SNP is called Minnesota Senior Health Options (MSHO). MSHO combines Medical Assistance with Medicare to provide coverage to seniors in Minnesota.

To find out if you’re eligible for an MSHO plan, you can get information from:

Does Medicaid cover all medical expenses?

While Medicaid doesn’t cover everything, it can help bridge the gap between what Medicare does and doesn’t cover, including helping pay for Medicare premiums, copays, coinsurance, deductibles and other out-of-pocket expenses.

What Medicaid does not cover for seniors

What’s not covered under Medicaid varies by state, but common things that aren’t usually covered include:

• Dental services that are considered cosmetic or not medically necessary
• Elective surgical procedures
• Over-the-counter (non-prescription) medications
• Non-emergency transportation (In Minnesota, however, this is covered by MSHO)
• Supplements, vitamins and herbal remedies

There are also specific things MSHO plans don’t cover, including:

• Investigational or experimental medications or devices
• Medical cannabis
• Medications used for erectile dysfunction or weight loss
• Missed medical appointments

The process of applying for Medicaid for elderly parents

As a caregiver, you may need to help a senior apply for Medicaid. In some cases, you can know before applying that they’ll qualify. For example, if they’re already receiving Supplemental Security Income (SSI), they’ll automatically qualify.

In other situations, it may help to speak to an expert, like an elder law attorney or a Medicaid planning professional. As Medicaid eligibility varies by state, so do the documents needed to apply. An expert can help you get documents in order and help you understand the income and asset requirements of your state.

Understanding Medicaid eligibility for elderly residents

In most cases, you need to wait until age 65 to sign up for Medicare. There isn’t an age requirement for Medicaid, so you can look at your individual situation to figure out if you qualify for Medicaid.

Because Medicaid is funded by both the federal government and individual states, your eligibility largely depends on the state you live in. But no matter where you live, there are three conditions you must meet before you apply:

• You must be a U.S. citizen or an eligible non-citizen
• You must live in the state you apply in
• Your income must be at or below the federal poverty level

After that, eligibility is based on:

• Age – You’re considered a senior at age 65
• Income level – Social Security Income, pensions and retirement plans, investment income, earned income (if you continue working past 65), and other sources like public assistance programs and veterans benefits all count as income for seniors and Medicaid

From there, eligibility varies by state, but here are the ways seniors may be considered eligible:

Once you’ve determined you’re eligible, you’ll need information and documents to prove it to your state’s Medicaid agency. This can include:

• Your full name and date of birth
• Your social security number
• How much you pay each month for rent or mortgage, or utilities
• Proof of citizenship or immigration status
• Proof of income, like a W-2 or paystub
• Verification of other government benefits you may receive
• Information about insurance plans you’ve had or currently have