State-by-state variations in Medicaid eligibility regulations always involve a cap on income and other resources. Additionally, there are items that Medicaid will or will not include in those limits. Many wonder if Medicaid counts Social Security Disability Insurance (SSDI) benefits as income.
Yes, Medicaid will typically include your Social Security benefits in determining your income eligibility. It includes Social Security retirement benefits, SSDI, and survivor’s benefits. However, Medicaid does not consider Supplemental Security Income (SSI) as part of your income.
The following article explains what factors matter and what does not count when assessing your financial eligibility for Medicaid.
What Kind of Income Counts Toward Medicaid?
Your modified adjusted gross income (MAGI) is used by Medicaid to determine your eligibility, MAGI is your Adjusted Gross Income (AGI) plus a few items, like exempt or excluded income and certain deductions. Medicaid will typically take the following into account when determining your income cap:
- Alimony payments
- Capital gains and investment income
- Dividends from stocks and bonds.
- Estate income
- Interest payments
- IRA distributions
- Non-taxable foreign income
- Pensions
- Rental and royalty income
- Retirement and pension income
- SSDI
- Social Security retirement benefits
- Social Security survivor’s benefits
- Unemployment compensation
- Wages, tips, and self-employment income
What Kind Of Income Is Excluded From Medicaid?
Medicaid does not consider other sources of income when determining your eligibility. These consist of:
- Child support
- Worker’s compensation
- Beneficiary payments
- Injury payments
- Insurance proceeds
- Veteran’s benefits
- Federal income tax refunds
- Relocation pay
- Temporary Assistance for Needy Families (TANF) remittance
- Aid to Families with Dependent Children (AFDC) remittance
- Gifts
- Supplemental Social Security income
How Are Married Couples’ Incomes Calculated for Medicaid?
The income threshold for individual applicants is relatively simple to understand. When the sum of the person’s MAGI is less than the Medicaid eligibility threshold, they are considered eligible.
Medicaid does not simply add up the combined income of married couples.
Your income may be counted individually, or Medicaid may consider you and your partner’s combined income, depending on the state where you reside and the particular type of Medicaid program you are applying for.
Maximum Income to Be Eligible For Medicaid
Medicaid eligibility requirements, including income caps, are decided independently by each state.
The Federal Poverty Level (FPL) serves as a yardstick for Medicaid when determining a person’s eligibility.
If a person’s income is at or below 150% of the FPL, they are generally eligible for Medicaid in the states that provide it to low-income adults. Depending on your residence and the kind of Medicaid you seek, a different income threshold may apply.
Medicaid: Is It Paid from Social Security?
Your Social Security check is not used to pay your Medicaid benefits. Your Social Security benefits could be reduced for a variety of other reasons, including:
- Collecting unpaid taxes
- Deduction of child, spousal, or family support responsibility
- Court-order victim restitution
- Overpayment of benefits
- Medicare Part B premiums
There may be a Medicaid premium that some people must pay. Still, it will not be taken out of your Social Security check.
Medicare Part B Premiums
The usual monthly Medicare Part B premium in 2023 is around $164.90. The majority of individuals pay this amount. However, your Part B costs may be higher depending on your income. Some beneficiaries of Social Security may contribute less.
Individuals and married couples with reported 2021 incomes of over $97,000 and $194,000, respectively, may have to pay extra for their Part B coverage starting in 2023. The Medicare IRMAA, or Income-Related Monthly Adjustment Amount, is the name of this additional amount.
Medicare Costs for 2023
With any type of Medicare plan, various expenditures could be included.
Deductible
Your Medicare deductible is the amount you must pay before your Medicare coverage begins as part of a covered service.
Premium
You must continue paying a Medicare premium to keep your coverage. Monthly payments are typical for Medicare premiums.
Copayments
After meeting your deductible, you might have to pay a predetermined sum (for instance, $20) for healthcare services. There could be additional expenses, depending on the sort of Medicare coverage you have.
Coinsurance
Coinsurance, typically 20 percent, is the portion of medical expenses you are responsible for after your deductible has been met.
Medicaid and Medicare: Am I Eligible for Both?
You might be qualified for both Medicare and Medicaid depending on your age, financial situation, and existence of a qualifying disability. If that is the case, you will be regarded as a “dual eligible” beneficiary.
Beneficiaries with dual Medicare and Medicaid coverage eligibility may be enrolled in both programs. If there are any Dual Eligible Special Needs Plans (D-SNPs) available in your area, you might also be able to sign up for one, depending on where you live.
Who Qualifies for Both Medicaid and Medicare?
You must fulfill the conditions for your state’s Medicare and Medicaid programs to be Medicare dual-eligible.
The following are a few conditions to qualify for Medicare:
- Have a qualifying disability or be at least 65 years old
- Have U.S citizenship or be a legal permanent resident
- Be able to receive payments from the Railroad Retirement Board or Social Security
Medicaid generally offers low-income people, families, kids, and expectant mothers health insurance. The best way to determine your Medicaid eligibility is to visit your state’s Medicaid website.
Talk to a licensed insurance agent or an advocate or representative from the SSA to learn if you are qualified for a dual-eligible Medicare and Medicaid plan. They can assist you in comparing the plans that are offered in your area and learning about the benefits they each have, such as prescription drug coverage and other services.
Final Words
For those looking for medical insurance, it is critical to understand how SSDI and Medicaid interact. While Social Security Disability benefits are often considered when assessing Medicaid eligibility, other exceptions exist, such as Supplemental Social Security income.
It’s important to understand what forms of income Medicaid counts and does not count. Additionally, based on the state and Medicaid programs, the income assessment procedure may differ for married couples.
Finally, understanding the income restrictions imposed by your state and the possible deductions from your Social Security benefits can help people navigate the complexity of Medicaid and guarantee they get the necessary healthcare coverage.
