Most older adults who have worked are likely to qualify for Medicare after they retire. Medicare benefits can help retired adults connect with basic healthcare support during their golden years. However, those in need of more extensive support may eventually require Medicaid coverage instead.
Those who suffer major injuries and require more than a month in a rehabilitation facility may need Medicaid due to Medicare limits. Older adults trying to age in place may need Medicaid to help pay for in-home nursing support. Additionally, Medicaid coverage is necessary for those moving into nursing homes in most cases.
If people have retirement income that makes them ineligible for Medicaid, they may want to spend down their resources to help them qualify for coverage. What does that process typically entail?
Spenddown involves covering costs out of pocket
A Medicaid spenddown plan involves using income and resources to cover medical care costs not covered by Medicare. Some people refer to this as a form of Medicaid deductible. If they spend enough of their excess income, they can qualify for Medicaid benefits for their ongoing long-term care costs.
Every state has a different spenddown period that professionals review when determining benefit eligibility. In North Carolina, residents hoping to qualify for Medicaid for long-term care costs typically face a six-month spenddown period. They have to spend enough over the course of six months to meet the income eligibility for Medicaid.
Eligibility and income limits
The limits for qualifying for Medicaid depend on the kind of benefits people require. Income limits are higher for nursing home care than for home-based services. In cases where assets, not income, leave someone ineligible for benefits, they may need to spend their countable assets improving or maintaining non-countable assets, such as their home.
Following the right procedures can help people obtain the coverage they need to pay for the care they require. Spenddown efforts can be part of a broader Medicaid planning endeavor. Reviewing support needs and financial records with a skilled legal team can help people establish the best plan for obtaining Medicaid if they require more intensive care later in life. Spending resources to cover care costs is only one of several strategies that can help people qualify.