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Could you or an elderly parent qualify for Medicaid? Use our step-by-step guide to check eligibility and submit an application form online or by phone. " width="1337" height="615" />
Did you know? Medicaid insures over 83 million Americans with limited income and resources—including 7.2 million older adults who also have Medicare.
Each state sets its own Medicaid eligibility and coverage rules. In some cases, you may qualify for benefits based on your income alone.
The process may seem complicated, but it doesn’t have to be. If you think you might qualify for Medicaid, you should apply. Our guide shows you how.
Medicaid is a vital public health insurance program for people with low income and limited resources. More than 83 million Americans are currently enrolled in the program, including 7.2 million older adults. 1,2
Jim, a 77-year-old Oklahoma resident, is one of them. When Jim’s wife of 56 years suddenly died, he faced two significant losses: the love of his life, and the income she earned that helped cover their out-of-pocket Medicare costs. When staff at his local Senior Center helped him apply and qualify for Medicaid, he was delighted.
“Medicaid is truly a lifeline for people like Jim,” said Jen Teague, Director of Health Coverage and Benefits at NCOA. “Not only does it remove a significant barrier to his insurance coverage right now—it also can help pay for any long-term nursing care he may need in the future.”
Jim had help navigating his Medicaid application. But many eligible older adults never submit an application because the process can feel overwhelming—or they don’t realize they qualify for assistance. For instance, did you know that millions of Americans age 65 and over like Jim receive both Medicare and Medicaid benefits?
“That’s why, if you think you or someone you know might qualify for Medicaid, you owe it to yourself to apply,” Teague said.
First, it’s important to know that individual states manage their own Medicaid program. That means that your eligibility and coverage will depend on where you live (the federal government does require certain mandatory benefits for everyone). It also means that you will apply for benefits directly with your state Medicaid agency.
Still, the overall process is similar regardless of where you live. Get started by following the steps below.
You may qualify for Medicaid based on your income, your age, your disability status, and other factors. While each state sets its own rules, you must at minumum 3 :
In certain states with expanded Medicaid coverage, you could qualify for coverage based on your income alone if you are age 65 or under.
The best way to check your Medicaid eligibility is to contact your state's Medicaid office. You can also visit HealthCare.gov to see if you qualify for Medicaid based on your income.
Having everything you need on hand before you fill out your Medicaid application can help you feel prepared. While your state may ask for additional information, start by collecting these basic documents 4 :
Keep in mind that each state defines “countable assets” differently. In some, for instance, your primary residence, one automobile, and certain other personal property are exempt from consideration. You may wish to consult a knowledgeable professional who can offer unbiased advice about your specific situation. If you are age 65 or older, your State Health Insurance Assistance Program (SHIP) can be a good place to start.
There are two ways to apply for Medicaid: through your state Medicare agency or the Health Insurance Marketplace.
Depending on which state you live in, you may be able to apply for Medicaid online. In some instances, you also may apply over the phone, in person, or by mail using a hard copy Medicaid application form.
There is no set enrollment period for Medicaid, which means you can submit your application at any time. Your local SHIP program can also help fill out your application.
You should receive a benefits decision within 90 days of submitting your Medicaid application. 5 Most states (48) are able to determine benefits within 24 hours or less, though not all of them do. 6
If you are eligible, you will get a notification letter in the mail telling you when your coverage will begin and how much you will pay for it out of your own pocket. 5
If your Medicaid application is denied, you will receive a different letter explaining why. This letter will also include information about how to appeal the decision. 5
At any time, you may check the status of your application by contacting your state Medicaid agency.
If you’re unhappy with the decision regarding your Medicaid benefits, you’re entitled to an appeals hearing. 7 You can initiate the appeals process by contacting your state Medicaid agency and letting them know. You can also use your Medicaid denial notice. Write “I disagree with this decision and want to appeal it.” Sign and date the document and either mail it to your local Medicaid office or—more preferably—drop it off in person (be sure to keep a copy for your records). Within a few weeks, you should receive a letter from your state with details about your hearing.
Yes. Medicaid is one piece of the puzzle, but there are many other financial benefits programs available that help older adults pay for health care, prescription medications, food, housing costs, and more. NCOA’s BenefitsCheckUp® is a free online tool where you can browse for programs near you. Simply type in your ZIP code to get started—no need to create an account.
