Does Medicaid Have a Deductible?

Medicare Benefits Solutions
Aug 13, 2021

Over 74 million people in the United States are enrolled in Medicaid. This federal and state-run healthcare program provides benefits for people living on a low income, or who have disabilities. Medicaid also covers services like nursing home care and home health care that aren’t included in Medicare benefits. 

Who Qualifies for Medicaid?

Medicaid eligibility is based on individual or family income, and family size. In every state, Medicaid is available for qualifying people who are low-income, families and children, pregnant women, seniors, and those who have disabilities. In some states, Medicaid provides coverage for all adults living below an income level that is set by the state.

Because Medicaid eligibility requirements are set by the state, you must check with your state’s Medicaid website to see if you qualify. 

Other requirements for Medicaid qualification are:

  • Citizenship or lawful permanent resident of the U.S.
  • Residency in the state where you get Medicaid coverage
  • Some eligibility requirements involve age, parental status, and pregnancy

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Does Medicaid Have a Deductible?

Yes, for many people, Medicaid has a deductible. A deductible is an amount of money that a beneficiary must reach by paying his/her own medical expenses before the insurance provider begins paying expenses on the beneficiary’s behalf. For example, if you have a deductible of $500.00, you pay your medical expenses out-of-pocket up to $500.00. After that, the insurance begins paying your expenses.

Your Medicaid deductible is determined by taking your countable monthly income, subtracting the Medicaid “Medically Needy” monthly income allowance, and multiplying the result by six. 
Your deductible amount is computed for a six-month period, which is the normal certification period for Medicaid. When this period ends, you must meet the deductible amount once again before Medicaid begins paying your expenses. The Department of Human Services sends you your Deductible Notice when you apply for Medicaid. This tells you what your deductible amount is. 

Can You Have Medicaid and Medicare Benefits Together?

There are over 12 million people in the U.S. who are enrolled in Medicare and Medicaid and are known as dual-eligible beneficiaries. 

Eligibility requires them to meet federal regulations for Medicare and their state of residence regulations for Medicaid. To qualify for Medicare a person must either be 65 or older or under 65 with a disability. 

For dual-eligible beneficiaries, there are different levels of assistance. People with full eligibility have Medicare and get full Medicaid benefits. Some people are partially dual eligible and get help from Medicaid to pay Medicare premiums or cost-sharing expenses. 

What are Dual Eligible Special Needs Plans (D-SNPs)?

D-SNPs are special needs plans geared for people who have both Medicare and Medicaid. Depending on which eligibility requirements the beneficiary meets, states may pay some of their Medicare expenses. 

Eligibility Requirements for D-SNP Coverage Include:

  • Verification of Medicaid coverage by showing either your Medicaid card or a letter from Medicaid Services.
  • Some SNPs require that you receive full Medicaid benefits for eligibility. If you are enrolled in a Medicare Savings Program you must find a D-SNP that accepts you.

If you qualify for enrollment, you can sign up for the SNP during a Medicare Advantage enrollment period. You may also qualify for a Special Enrollment Period (SEP) if the following apply:

  • You have Medicare and Medicaid
  • You have a severe and chronic health condition
  • You are being admitted to a facility where you qualify for SNP, or you need skilled nursing care at home.

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