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A12 BUSINESS
Thursday 14 sepTember 2023

Income too high for Medicaid? ‘Spend

down’ to qualify

By ALEX ROSENBERG
of NerdWallet
More than 1.4 million peo-
ple have lost Medicaid
coverage in 2023 because
they no longer meet the
eligibility requirements, ac-
cording to August tracking
data from KFF, a health
policy nonprofit.
After a pause on disen-
rollments during the CO-
VID-19 public health emer-
gency, beneficiaries now
must prove that they still
meet the income limits for In this Nov. 8, 2018 file photo, the U.S. Medicare Handbook is
Medicaid. People whose photographed in Washington.
income has gone up risk Associated Press
losing their coverage.
What some beneficiaries as those with certain dis- aid and another kind of
might not realize is that abilities, children or people coverage, they can work
even if their income seems age 65 and older, are eligi- together to pay for your
too high for Medicaid, they ble to spend down income care. For example, if you
might be able to spend to qualify for Medicaid. have both Medicare and
down some income to Rules for who counts as Medicaid, Medicare pays
qualify. For certain ben- medically needy vary for services first, and then
eficiaries, spending on by state. For example, in Medicaid pays for addi-
medical bills, including Washington, D.C., parents tional costs that Medicare
Medicare premiums, can or caretakers of children didn’t cover, such as cer-
be subtracted from their under 21 years old, preg- tain copays, coinsurance
income when applying for nant people and people and deductibles.
Medicaid. living in nursing homes can BENEFITS FOR MEDICARE
WHAT IS A MEDICAID also spend down to be- BENEFICIARIES
SPEND-DOWN? come eligible for Medic- For people age 65 and old-
A spend-down is like a aid. er and those with certain
health insurance deduct- HOW DOES SPENDING disabilities, Medicare cov-
ible, according to Catrice DOWN AFFECT MEDICAL ers most health care, but
Simpson, a supervisory so- BILLS? not everything.
cial service representative Spending down to meet “There’s often the miscon-
for the Washington, D.C., the income requirements ception that Medicare will
Department of Health for Medicaid means that pay for long-term care,
Care Finance. “It is the Medicaid can cover some and it will not,” says Con-
amount you must show of your medical bills. But it necticut elder law attorney
proof of meeting or ex- won’t cover the bills you Daniel Tully.
ceeding before the insur- used to qualify. Medicaid does cover
ance plan starts to pay, in For example, if you pay long-term care, Tully says,
this case it’s before Medic- $300 out of pocket for a and could be an option
aid starts to pay,” Simpson doctor’s visit and subtract for those facing high costs
wrote in an email. that amount from your in- Medicare won’t cover.
For example, someone come, Medicaid won’t re- Those beneficiaries might
with income $200 above imburse you for it later. But be able to qualify by
their state’s limit for Medic- additional bills you didn’t spending down or taking
aid might become eligible use for the spend-down other estate planning ac-
if they have at least $200 in could be covered by Med- tions such as establishing a
qualifying medical bills. icaid. Medicaid-compliant trust,
People who qualify as If you have both Medic- Tully says.
“medically needy,” such Medicare beneficia-
ries who spend down to
qualify for Medicaid get
an additional benefit: the
“Extra Help” subsidy. Extra
Help pays for the premi-
ums, deductible and most
of the out-of-pocket costs
for Medicare Part D, which
covers prescription drugs.
The government estimates
that it’s worth about $5,300
per year.q