Can I stay on Medicaid when I turn 65? Your Guide to Continuous Coverage

According to the Centers for Medicare & Medicaid Services, over 12 million people are enrolled in both Medicaid and Medicare, a status known as 'dual eligible'. Understanding this unique situation is key for those asking, Can I stay on Medicaid when I turn 65? This guide offers comprehensive details to help navigate your healthcare transition with confidence.

Quick Summary

It is often possible to remain on Medicaid after age 65 by qualifying for specific programs for older adults, even while simultaneously enrolling in Medicare. Continuing your coverage hinges on meeting your state's particular income and asset requirements for seniors, which differ from those for younger adults.

Key Points

• Dual Eligibility is Possible: Many individuals can become 'dual eligible,' receiving benefits from both Medicare and Medicaid after age 65.

• Eligibility Rules Change: When you turn 65, Medicaid eligibility often switches from MAGI-based income rules to stricter SSI-based income and asset limits.

• State Rules Vary: Medicaid is administered by states, so eligibility and program details can differ significantly depending on where you live.

• Medicare Savings Programs Offer Aid: If you lose full Medicaid, state-run Medicare Savings Programs can still help cover Medicare premiums and out-of-pocket costs.

• Start Planning Early: Begin researching your options and contacting your state's Medicaid office several months before your 65th birthday to ensure a smooth transition.

• Asset Limits Exist for Seniors: Unlike ACA expansion Medicaid, eligibility for seniors is means-tested and includes restrictions on assets like savings accounts.

• Medicaid Becomes Secondary: For dual-eligible individuals, Medicare becomes the primary payer for services, with Medicaid picking up secondary costs.

Your Healthcare Transition at 65: What to Expect

As you approach your 65th birthday, your healthcare coverage options will undergo a significant change. While many people automatically transition to Medicare, those who have relied on Medicaid may be concerned about losing their benefits. The good news is that for many, keeping Medicaid is a viable option, often alongside Medicare. This transition requires a proactive approach and a clear understanding of the rules, which shift once you reach retirement age.

The Shift in Medicaid Eligibility at Age 65

One of the most important distinctions to grasp is the change in how Medicaid eligibility is determined. For adults under 65 in states that expanded Medicaid under the Affordable Care Act (ACA), eligibility is based on Modified Adjusted Gross Income (MAGI), which does not consider assets. However, once you turn 65, this changes. Medicaid eligibility for older adults is typically based on Supplemental Security Income (SSI) rules, which do include limits on both income and assets.

Key Differences in Eligibility

Feature	Medicaid Under 65 (Expansion)	Medicaid After 65 (SSI-Related)
Income Test	Based on Modified Adjusted Gross Income (MAGI).	Based on Supplemental Security Income (SSI) methodologies, typically with lower limits.
Asset Test	No asset limit in most expansion states.	Strict asset limits (e.g., ~$2,000 for an individual) in most states.
Covered Services	Broad coverage for medical services, but long-term care may be limited.	Can cover long-term care services, including nursing home care and home-based care.
State Variation	Varies by state; some have expanded, some have not.	Varies by state, including whether they follow SSI rules or more restrictive criteria.

Understanding Dual Eligibility for Both Programs

If you continue to meet Medicaid's income and asset requirements after turning 65, you can have both Medicare and Medicaid. This is referred to as being 'dual eligible'. In this scenario, Medicare acts as your primary insurance, and Medicaid functions as your secondary coverage. Being dual eligible offers substantial benefits, including:

• Comprehensive Coverage: Medicaid can cover services that Medicare does not, such as long-term care, some prescription drugs, and vision or dental services.
• Reduced Out-of-Pocket Costs: Medicaid helps cover Medicare premiums, deductibles, and copayments, significantly reducing your out-of-pocket expenses.
• Enhanced Prescription Drug Coverage: Most dual eligibles receive 'Extra Help' automatically, a program that lowers prescription drug costs for Medicare Part D.

Navigating State-Specific Rules

Because Medicaid is a joint federal and state program, eligibility rules and benefits vary significantly by state. Some states, known as '209(b) states,' use more restrictive eligibility criteria than the federal SSI program. Other states have 'medically needy' programs that allow you to become eligible for Medicaid by 'spending down' your income on medical expenses.

• Check Your State: It is crucial to contact your state's Medicaid agency or a local State Health Insurance Assistance Program (SHIP) office to understand the specific rules that apply to you. Some states automatically transition eligible individuals to an aged, blind, and disabled program, while others require you to reapply.

Options If You No Longer Qualify for Medicaid

If your income or assets exceed the limits for aged Medicaid, you might lose your full Medicaid benefits. However, you are not without options for financial assistance. Several programs exist to help low-income seniors with their Medicare costs:

1. Medicare Savings Programs (MSPs): These state-administered programs can help pay for some or all of your Medicare Part B premiums. There are different levels of MSPs with varying income and asset limits.
2. Extra Help: The federal Extra Help program assists with Medicare Part D prescription drug costs. Eligibility is determined based on income and resources, and if you are dual eligible, you receive it automatically.
3. State-Specific Assistance: Some states offer additional programs to help with healthcare costs, so it is always worth investigating your local options.

A Step-by-Step Plan for Your Transition

To ensure a smooth transition and maintain your healthcare coverage, follow these steps:

1. Plan Ahead: Begin reviewing your options several months before your 65th birthday. This will give you ample time to gather necessary documents and understand your state's requirements.
2. Contact Your State Medicaid Office: Reach out to your state's Medicaid agency to confirm your continued eligibility and to find out about any necessary application or renewal processes.
3. Apply for Medicare: As a condition of continued Medicaid eligibility in many states, you are required to apply for Medicare once you become eligible. This will also ensure that you have primary coverage.
4. Explore Dual-Eligible Special Needs Plans (D-SNPs): If you are dual eligible, you may want to consider a D-SNP, a type of Medicare Advantage plan designed specifically for people with both Medicare and Medicaid. These plans often provide additional benefits and coordinate your care between both programs.
5. Utilize Expert Resources: If you find the process overwhelming, don't hesitate to contact a local SHIP counselor for free, unbiased advice. You can find contact information and resources at medicare.gov.

Conclusion: Proactive Planning is Key

Turning 65 brings changes to your healthcare, but it doesn't have to mean losing your valuable Medicaid benefits. By understanding the distinction between pre- and post-65 eligibility rules, planning for the transition, and exploring dual eligibility and other assistance programs, you can secure continuous and affordable healthcare. Taking a proactive approach will ensure you are well-prepared to navigate this important life change and continue to access the care you need.

Frequently Asked Questions

Do I have to switch from Medicaid to Medicare at 65?

You do not have to switch, but once you become eligible for Medicare, you are often required to apply for it. If you still meet the criteria for Medicaid for older adults, you can have both and become 'dual eligible.'

What is a 'dual eligible'?

A dual eligible is a person who qualifies for and is enrolled in both Medicare and Medicaid. For these individuals, Medicare is the primary payer for most medical services, and Medicaid covers additional costs and services.

Will I lose my Medicaid coverage automatically at 65?

Not automatically, but your eligibility will be re-evaluated based on the rules for older adults, which often include strict income and asset limits. Many people need to transition from expansion Medicaid to an aged-and-disabled Medicaid category.

What are the asset limits for aged Medicaid?

Asset limits vary by state and are typically low (e.g., around $2,000 for an individual). Certain assets like your primary residence and one vehicle are often excluded, but savings and retirement accounts are usually counted.

What are Medicare Savings Programs?

Medicare Savings Programs (MSPs) are state programs that help pay for some or all of your Medicare Part A and B premiums, deductibles, and coinsurance. They are for low-income individuals who do not qualify for full Medicaid.

What services are covered when I have both Medicare and Medicaid?

Having both programs provides comprehensive coverage. Medicare pays first for covered services, and Medicaid typically covers Medicare premiums and copayments. Medicaid can also cover services not covered by Medicare, such as long-term care and vision.

Where can I find help with this transition?

You can get assistance from your state's Medicaid office or a local State Health Insurance Assistance Program (SHIP). These resources can provide personalized advice based on your circumstances and location.