Many seniors reach a point during their retirement years where they need to qualify for Medicaid benefits in order to help cover the high cost of long-term care. If you are one of them, and the entire Medicaid program is new to you, there is a good chance you are feeling a bit intimidated by the application process. The best way to ensure that you will be approved for Medicaid benefits when you need them is to start by understanding the New York Medicaid eligibility guidelines.
Why Would I Need Medicaid as a Senior?
Like many seniors in your position, you may have made it through your entire working years without ever needing to turn to Medicaid for help with your healthcare costs because you had employer sponsored or private health insurance coverage. For most people, however, that coverage stops when they reach retirement age. At the same time though, your odds of needing long-term care increase dramatically. At age 65 you stand about a 50 percent chance of one day needing long-term care (LTC). By age 85, those odds increase to a 75 percent chance.
Even if you still have health insurance coverage it will likely not cover LTC expenses nor will Medicare. At an average cost in the State of New York of over $130,000 per year, paying for LTC out of pocket is not an option for most people. This is where the need to qualify for Medicaid comes into the picture because Medicaid does cover LTC expenses. Qualifying for Medicaid, however, can be a challenge if you failed to plan ahead by including Medicaid planning in your comprehensive estate plan.
New York Medicaid Eligibility Guidelines for Seniors
The reason it can be a challenge to qualify for Medicaid is because the program is a “needs based” program, meaning that an applicant must demonstrate a “need” for the benefits in order to qualify. With Medicaid, this means an applicant must have income and assets that fall below the program limits. Just to make things even more complicated, both the income and asset limits are subject to change. Furthermore, the limit that applies to your situation will depend on a number of factors such as which Medicaid program you are applying for and your household size. To get an idea of how relatively low the limits are, however, the following are examples of some 2016 income and asset limits that apply to New York Medicaid eligibility:
- The monthly income limit for a family of one seeking community based Medicaid, meaning care in the home, is $845.
- The monthly income limit for a spouse of an applicant seeking coverage for nursing home care is $2,980.50.
- The resource or asset limit for a family of one seeking community based Medicaid is $14,850 plus $1,500 in a separate burial account.
- The spouse of an applicant seeking coverage for nursing home care is allowed between $74,820 and $119,220 in resources, plus $1,500 in a burial account.
What Assets Count?
Fortunately, not all of your assets are counted when determining the value of your “countable resources” for the purpose of determining Medicaid eligibility. Some common exempt assets include:
- family residence (in some cases)
- irrevocable pre-paid burial expenses
- personal and household property
- one automobile
- any life insurance policies with a face value of less than $1,500
If your non-exempt assets are valued above the applicable program limit, Medicaid will impose a waiting period during which time you will be expected to “spend-down” your non-exempt assets. In short, you will be expected to use your nest egg to cover your LTC expenses before Medicaid will help. Transferring those assets at the last minute won’t work either because Medicaid uses a five-year look-back rule that allows Medicaid to review your assets for the last five years and discount any asset transfers for less than full market value. This is why incorporating Medicaid planning into your estate plan well ahead of time is so important. If you did not do so, however, and you suddenly need to qualify for Medicaid, an experienced New York Medicaid planning attorney may be able to implement some last-minute Medicaid planning strategies that can help protect at least some of your assets.
For more information, please download our FREE estate planning worksheet. If you have questions or concerns relating to New York Medicaid eligibility, contact the experienced Medicaid planning attorneys at the Law Offices of Kobrick & Moccia by calling 800-295-1917 to schedule your appointment.