Medical and Safety Resources
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Navigating Health Care
Government Medical and Health Programs
As seniors age, the importance of having access to safe, reliable health care services grows exponentially. Seniors often require medical care from specialists and primary care physicians, prescription medications and in some cases, long-term care services. Thankfully, government organizations, such as the Centers for Medicare and Medicaid Services, have been consistently growing and evolving program availability for seniors, so those who need it can access better coverage.
According to CMS Administrator Seema Verma, “CMS remains committed to transforming the health care delivery system through initiatives like MCIT that focus on results, removing government barriers to advancing innovations, fostering competition and ensuring quicker access to the most advanced therapies.” This comes as good news for seniors who require financial help to access medical care, particularly those who take advantage of non-traditional therapies and health care technology.
Seniors across the U.S. can access one or both of the two health benefits packages that are designed to accommodate those with low to moderate incomes: Medicaid and Medicare.
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Medicaid is available to seniors, families and individuals who have incomes that are no more than 135% above the federal poverty line plus $20; however, each state may raise the eligibility limit to align with average incomes within the geographic area. Those who receive SSI payments are considered automatically eligible.
While regular Medicaid covers the cost of typical medical expenses, such as primary and ambulatory care, physical therapy, nursing care and prescription medications, most states also offer coverage exceptions, known as waiver programs. Under these waivers, low-income seniors may be able to access personal care or medical services while residing in assisted living or receiving in-home care.
To qualify for Medicaid as a senior citizen, applicants must:
- Meet their state’s income and asset requirements
- Be at least 65 years of age or legally blind or disabled
- Be a U.S. citizen or permanent resident
- Reside in the state that issues their Medicaid coverage
Spousal Impoverishment
Often, when a senior moves to a nursing home, their spouse remains at home or within another community receiving a lower level of care. Medicaid has provisions in place to ensure spouses who are not receiving nursing care aren’t left without any remaining income or resources. This spousal impoverishment provision protects a specified amount of the couple’s combined income and assets and appoints them to the spouse who is still residing at home. “While this spousal impoverishment provision provides many community-dwelling spouses some level of protection, those with significant assets may consider consulting with a qualified elder law attorney to discuss possible asset preservation strategies,” recommends Mr. Levesque.
How to Apply
Seniors who wish to receive Medicaid coverage can apply online through the Health insurance Marketplace or contact the Medicaid agency for their state. These state agencies can also provide assistance with the application process and answer questions about eligibility.
Seniors aged 65 and older can sign up for Medicare, which provides health care coverage in several components:
- Part A: Covers inpatient hospital care
- Part B: Covers outpatient care and primary medical services
- Part C: Also known as Medicare Advantage, this offers seniors a different way to receive their benefits while accessing additional coverage for services, such as dental and eye care
- Part D: Covers prescription drugs
When a senior initially enrolls in Medicare, they’ll purchase Part A and Part B only. Once their coverage is in place, they can explore other options, such as switching to Part C or adding Part D coverage, should they choose to do so. Coverage is not free. Medicare is administered through private health insurance companies, and the cost of Medicare varies depending on factors, such as coinsurance, deductibles and the amount of coverage purchased.
To be eligible for Medicare, seniors must be aged 65 and older, and they must be U.S. citizens or permanent residents.
Medicare Savings Program
Seniors who are considered low income may qualify for a Medicare Savings Program. These programs can help seniors pay for their premiums, as well as deductibles, coinsurance and copayments. There are four types of savings programs:
- Qualified Medicare Beneficiary
- Specified Low-Income Medicare Beneficiary
- Qualifying Individual
- Qualifying and Working Individuals
Each of these programs has different asset and income requirements, which are generally updated on an annual basis.
How to Apply
Seniors must apply for Medicare coverage during their Initial Enrollment Period to avoid paying a late enrollment penalty. The enrollment period runs for a 7-month period, which starts 3 months before the senior’s 65th birthday, includes their birth month and continues for 3 months following their birthday. For those who enroll early, coverage begins on the day they turn 65.
To apply, seniors can contact their local Social Security office or complete the online application. Questions can be directed to Social Security at (800) 772-1213.