Frequently Asked Questions For Current Medicaid Beneficiaries
What is a Community Spouse?
A community spouse is someone whose husband/wife is currently institutionalized or living in a nursing home. The community spouse is not currently living in a nursing home and usually resides at the couple´s home.
I am a community spouse. Will I be allowed to keep any income or resources?
If your spouse is institutionalized or living in a nursing home, you will be permitted to keep some income known as a minimum monthly maintenance needs allowance . If you are currently receiving income in excess of the minimum monthly maintenance needs allowance, you may be asked to contribute twenty-five percent of the excess income to the cost of care for the institution
How do I find my local Medicaid office?
The Medicaid office is located in your local department of social services. A listing of offices can be located here:
If you live in the five boroughs of New York City, your offices are run by the Human Resources Administration . A listing of offices can be found here:
How do I order a new benefit card?
If your Medicaid is with your LDSS, to order a new Medicaid Benefit Identification Card, please call or visit your
If your Medicaid is with the and you need to order a new benefit card please call the call center at 1-855-355-5777.
Members residing in the five boroughs of NYC can call the HRA Infoline at 1 557-1399 or the HRA Medicaid Helpline at 1 692-6116.
How often do I have to renew?
Medicare Vs Medicaid: What Is The Difference
|Deductibles vary according to a persons specific plan. There are many plans with no deductible
|Part A: Coinsurance varies depending on the length of a hospital stay per benefit period. There is a $0 coinsurance for the first 60 daysPart B: There is a 20% coinsurance after youve met your deductible for Medicare-covered services
|Coinsurance and copayments vary according to plan
|There is no limit to your out-of-pocket costs
|Out-of pocket costs’ are capped. In 2021, the out-of-pocket maximum is $7,550, though some plans set lower limits. If youre in a plan that allows out-of-network coverage, theres a separate out-of-pocket limit for combined in- and out-of-network coverage of $11,300
What Are Dual Special Needs Plans
Dual health plans are also known as Dual Special Needs Plans . Theyre offered by private insurance companies, so you can find a dual health plan that best meets your health insurance needs. Being on a dual health plan does not change your Medicaid eligibility or benefits.
See UnitedHealthcare plans in your area
Dual-eligible or Medicaid plan benefits can change depending on where you live. Search using your ZIP code to find the best plan to meet your health care needs.
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Looking for the federal governments Medicaid website? Look here at Medicaid.gov.
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Who Pays For Medicaid
Medicaid does not pay money to individuals but sends payments directly to healthcare providers.
States make these payments according to a fee-for-service agreement or through prepayment arrangements, such as health maintenance organizations . The federal government then reimburse each state for a percentage share of their Medicaid expenditures.
This Federal Medical Assistance Percentage changes each year and depends on the states average per capita income level.
The reimbursement rate begins at 50% and reaches 77% in 2020. Wealthier states receive a smaller share than states with less money.
In the states that chose to expand their coverage under the Affordable Care Act, more adults and families on low incomes are eligible with the new provision allowing enrolment at up to 138% of the FPL. In return, the federal government cover all expansion costs for the first 3 years and over 90% of the costs moving forward.
Medicare is a federal health insurance program that funds hospital and medical care for older people in the U.S. Some people with disabilities also benefit from Medicare.
The program consists of:
- Part A and Part B for hospital and medical insurance
- Part C and Part D that provide flexibility and prescription drugs
Medicaid Va And Medicare Benefits
Long-Term Care Benefits for a Secure Future!
Medicaid is the primary funding source for long-term care for millions of middle-class Americans, providing vital long-term care coverage to those who qualify for the benefit.
Although the federal government establishes general guidelines for the program, states design, implement, and administer their own Medicaid programs. The federal government matches state expenditures on medical assistance based on the federal medical assistance percentage, which can be no lower than 50 percent.
In the fiscal year 2023, total federal Medicaid spending was $462 billion, funded by our tax dollars. States reported that the state share of Medicaid spending grew by 9.9% in FY 2022 but projected a sharper growth rate of 16.3% in FY 2023. Click here to learn more about this and other 2022-23 federal and state Medicaid enrollment and spending trends.
If you are smart enough to do legal and financial planning to get some of these tax dollars back to pay for your long-term care when you need it, its ethically no different than income tax planning, when you try to get the biggest income tax refund every year.
Veterans Aid and Attendance Figures:
Click here for all Veterans Aid and Attendance Figures and Rules.
Gift Tax Annual Exemption in 2023: $17,000
Gift Tax Lifetime Exemption in 2023: $12.92 million
Below are the Medicare amounts and how they have changed for the coming year:
Medicare Part A
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Get Important News & Updates
Sign up for email and/or text notices of Medicaid and other FSSA news, reminders, and other important information. When registering your email, check the category on the drop-down list to receive notices of Medicaid updates check other areas of interest on the drop-down list to receive notices for other types of FSSA updates.
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Unitedhealthcare Senior Care Options Plan
UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.
I Am A Veteran What Do I Need To Know
There are three things veterans should know about their health care options.
Additionally, enrollment in VA health care means you can receive:
- Immediate benefits of health care coverage. Veterans may apply for VA health care enrollment at any time.
- No enrollment fee, monthly premiums or deductibles. Most veterans have no out-of-pocket costs. Some veterans may have a small co-payments for health care or prescription drugs.
- More than 1,700 places to get your care. This means your coverage can go with you if you travel or move.
Veterans Enrolled in VA Health Care
For those currently enrolled in VA health care programs, your health care coverage meets the requirements under the Affordable Care Act. You have met the requirement to have health insurance that began in 2014. You do not have to take any additional steps to get health care coverage.
Depending on your income, you may also qualify for free or low cost coverage from Health First Colorado . Find out more on our I Need Health Insurance.
Veterans Not Enrolled in VA Health Care
What Is Medicare What Is Medicaid
Medicare is a federal program generally for people who are 65 or older or have a qualifying disability or medical condition. Medicare Part A and Part B are provided by the federal government, and Medicare Part C and Part D, while federally governed, are provided by private insurance companies.
Medicaid is a state government program that helps pay health care costs for people with limited income and resources, and different programs exist for specific populations. Medicaid plans vary from state-to-state but follow federal guidelines for benefits.
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If You Qualify Under A Non
- If you are a U.S. citizen and provide a valid Social Security Number , a match with the Social Security Administration will verify your SSN, date of birth and U.S. citizenship. If SSA verifies this information, no further proof is needed. The SSA match cannot verify birth information for a naturalized citizen. You will need to submit proof of naturalization or a U.S. passport.
- Proof of citizenship or immigration status*
- Proof of age , like a birth certificate
- Four weeks of recent paycheck stubs
- Proof of your income from sources like Social Security, Veteran´s Benefits , retirement benefits, Unemployment Insurance Benefits , Child Support payments
- If you are age 65 or older, or certified blind or disabled, and applying for nursing home care waivered services, or other community based long term care services, you need to provide information on bank accounts, insurance policies and other resources
- Proof of where you live, such as a rent receipt, landlord statement, mortgage statement, or envelope from mail you received recently
- Insurance benefit card or the policy
- Medicare Benefit Card **
Proof of Medicare application can be:
- Your award or denial letter from the Social Security Administration, OR
- Your on-line confirmation letter stating that you have applied for Medicare with the Social Security Administration.
The Majority Of The Public Holds Favorable Views Of Medicaid
Public opinion polling suggests that Medicaid has broad support. Seven in ten Americans say they have ever had a connection with Medicaid including three in ten who were ever covered themselves. Even across political parties, majorities have a favorable opinion of Medicaid and say that the program is working well . In addition, polling shows that few Americans want decreases in federal Medicaid funding. In addition to broad-based support, Medicaid has very strong support among those who are disproportionately served by Medicaid including children with special health care needs, seniors, and people with disabilities.
Figure 10: Large Shares Across Parties Say They Have a Favorable Opinion of Medicaid
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Does Medicaid Cost Me Anything
Some services may include a small copay, such as clinic visits, laboratory tests, medical supplies, overnight hospital stays, emergency room visits for nonâemergency services, prescription drugs, and over the counter drugs.
Certain people are exempt from copays entirely, including anyone who opts for a Managed Care Plan. Talk to your caseworker for more details about copays specific to you.
There is an annual limit of $200 for out of pocket copayments, after which you will not need to pay any more copays that year. No provider can refuse treatment for inability to pay and must bill you for unpaid copays if needed.
What Is Medicare Supplement Plan
Medicare Supplement, also known as Medigap, is a private policy that pays for things not covered under original Medicare. This secondary coverage plan will only apply to Original Medicare and will not apply to any Medicare supplemental coverage or supplemental health plans. In general, Medigap plans do not offer prescription drug coverage so you should consider enrolling into Medicare Part D or Medicare Advantage Plans. Medicare Part C is a program that differs from Medicare Advantage.
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Option : Medicare Advantage Plans
- Medicare Advantage Plans are a type of Medicare health plan offered by private companies that contract with Medicare to provide Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage.
- In Orange County, Medicare Advantage are either an HMO or PPO. Plan members are assigned a medical group and referrals are required prior to seeing a specialist. MA plans pay first, and Medi-Cal pays any remaining cost sharing amounts. Beneficiaries need only present their MA Plan card when obtaining medical services.
Already Enrolled In Medicare
If you have Medicare, you can get information and services online. Find out how to .
If you are enrolled in Medicare Part A and you want to sign up for Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.
You can use one of the following options to submit your enrollment request under the Special Enrollment Period:
- State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
- If possible, your employer should complete Section B.
- If your employer is unable to complete Section B, please complete that portion as best as you can on their behalf and submit one of the following forms of secondary evidence:
- Income tax form that shows health insurance premiums paid.
- W-2s reflecting pre-tax medical contributions.
- Pay stubs that reflect health insurance premium deductions.
- Health insurance cards with a policy effective date.
- Explanations of benefits paid by the GHP or LGHP.
- Statements or receipts that reflect payment of health insurance premiums.
Some people with limited resources and income may also be able to get .
Use The Ny Medicaid Doctors List
The best way to find a doctor in your area who accepts New York Medicaid plans is to use a provider search tool like ZocDoc. You can search by location, name, condition, procedure, or the type of doctor you are looking for. You can also use the official NYS Provider and Health Plan lookup tool to search by health plan, provider, or facility.Back to Top
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How Va Health Care And Medicare Work Together
Its possible to have VA and Medicare benefits at the same time. Having both types of coverage is helpful if you need specialized care, if you have a condition not connected to your military service, or if you want to use non-VA providers. Because the Department of Veterans Affairs assigns each beneficiary to a priority group that determines how much you pay for services, having Medicare is especially helpful if youre in one of the lower priority groups with higher out-of-pocket costs. If you decide to enroll in Medicare, your VA benefits pay for VA-authorized services, and Medicare pays for Medicare-covered services.
|MEDICARE PLAN TYPE
|Yes, because a Medigap plan can save you money if you have to seek care from a non-VA provider.
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Can You Have A Medicare Advantage Plan And Medicaid At The Same Time
Medicare Advantage plans are Medicare plans offered by private insurers, while Medicaid provides health coverage for low-income eligible Americans. In some cases, you can have both at the same time if you qualify for dual eligibility.
What you should know
|1. Medicare Advantage is a private Medicare plan, also referred to as Medicare Part C or MA plans.
|2. Medicaid is offered to those who meet low-income eligibility and covers additional health services that are not covered by Medicare.
|3. Dual eligibles can have both Medicare Advantage and Medicaid at the same time.
|4. Private healthcare providers offer specialized plans for dual eligibles that can coordinate Medicaid benefits with a Medicare Advantage plan.
For those who meet income eligibility, Medicaid can be an important resource for covering healthcare expenses that Medicare does not. In addition, some people can benefit from having both Medicaid and Medicare Advantage, which is Medicare coverage through private insurance companies. Those who qualify are known as dual eligibles. Learn more about how it works.
Can You Have Medicare And Medicaid
The short answer is yes. If you receive coverage from both Medicaid and Medicare, youre a dually eligible beneficiary. If you are dual eligible, you may be enrolled in Medicare and then qualify for Medicaid, or enroll first in Medicaid but later qualify for Medicare. Medicaid assists seniors with limited income and people with disabilities also enrolled in Medicare.
How does dual eligibility work?
Dual-eligible beneficiaries can have:
- Medicare Part AMedicare Part A, also called “hospital insurance,” covers the care you receive while admitted to the hospital, skilled nursing facility or other inpatient services. Medicare Part A is part of Original Medicare.
- Medicare Part BMedicare Part B is the portion of Medicare that covers your medical expenses. Sometimes called “medical insurance,” Part B helps pay for the Medicare-approved services you receive.
- Both Part A and Part B
- Full Medicaid benefits
- State Medicare Savings Programs
Medicare benefits always pay first, and Medicaid benefits assist with costs not fully covered by Medicare.
Medicaid will pay premiums and out-of-pocket expenses for dual-eligible Medicare beneficiaries. Medicare and Medicaid work together to cover costs, including long-term services. If you do not have full Medicaid benefits, Medicare Savings Programs may help cover some of those costs:
Are you eligible for cost-saving Medicare subsidies?