Some Medicaid Recipients May Have to Apply for Medicare in Order to Be Eligible

by David Goldfarb

For many New Yorkers, Medicaid benefits are a vital part of their overall health care plan. Maintaining these benefits are a crucial step toward ensuring they and their families receive needed medical care. However, some Medicaid recipients must first apply for Medicare as a condition of their eligibility for Medicaid. The experienced New York elder law attorneys at Goldfarb Abrandt Salzman & Kutzin can help you and your family access the state and federal healthcare benefits to which you are entitled.

How Do I Become Eligible for Medicare and Medicaid?

Medicare is a federal program of health care coverage. It consists of four separate coverages: Part A (hospital coverage), Part B (preventative care and outpatient services), and Part D (prescription medications). Part C allows private health insurance companies to provide Medicare benefits through plans known as Medicare Advantage Plans. Americans can become eligible for different coverages in different ways. Part A coverage can be earned at the age of 65 if the subscriber has paid Social Security taxes for at least forty calendar quarters. Those suffering from end-stage renal disease can also qualify for premium-free Part A coverage. Other subscribers can purchase this coverage for a premium. Part B plans are voluntary and require payment of separate premiums. A subscriber who has enrolled in Part A or B (or a Medicare Advantage Plan through Part C) may also enroll in a Part D plan for prescription medication coverage.

Medicaid is a program by which states provide health care coverage to eligible residents. Residents often must meet financial eligibility requirements to access these services. In some cases, they must also enroll in Medicare to qualify for Medicaid. The New York Office of Health Insurance Programs reports that Medicaid applicants or recipients must apply for Medicare if they are ages 64 and nine months, and have income at or below 120 percent of the Federal Poverty Level (or income at or below set state requirements for Medicaid eligibility). This rule targets those subscribers who are eligible for Medicare benefits and can, therefore, supplement their state benefits with federal benefits. It does not apply to Medicaid subscribers who are not also eligible for Medicare benefits. Younger subscribers who are eligible for Medicaid based upon financial eligibility are often not entitled to federal benefits.

These requirements can prove difficult to navigate successfully. Applicants may also have to appeal denials or other adverse determinations by the state. An attorney can help applicants successfully navigate the challenges of Medicare and Medicaid eligibility.

Protect Your Medical Coverage With the Counsel of a New York Elder Law Attorney

Don’t leave your health care to chance. Consult with an attorney to ensure that you are on all applicable plans that are available to you, that your claims are not denied, and that you have the full extent of coverage to which you are entitled. The elder law attorneys at Goldfarb Abrandt Salzman & Kutzin have decades of experience in ensuring that benefits are made available to those who deserve them. Call (212) 387-8400 or write to us today to schedule your consultation.