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The state where you reside has a significant impact on the care you receive and how much you pay as a Medicare beneficiary. This page describes resources to help you pay for Medicare coverage and Medicaid programs to may help pay for long-term care, which is not generally covered by Medicare.
Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for Medicare Savings Programs (MSPs). MSPs pay the Medicare Part B premium and – in some cases – Part A premiums and Medicare cost sharing.
Beneficiaries who are eligible for the MSPs in Alaska fall into four categories, which correspond to income levels:
MSP asset limits: Alaska uses the federal asset limits for QMB, SLMB Basic and SLMB Plus – which are $7,860 if single and $11,800 if married. The asset limit for QDWI is $4,000 for applicants living alone and $6,000 for applicants living with one other person.
The income and asset limits for QMB, SLMB Basic and SLMB Plus vary based on an applicant’s marital status, but eligibility rules for QDWI and other Medicaid benefits differ based on the number of household members (and not marital status).
Medicare covers many services, including physician visits, hospitalization, and skilled nursing care. But Medicare beneficiaries can face large out-of-pocket expenses (i.e. co-pays, coinsurance, and deductibles), and there are differences in benefits available under Original Medicare and Medicare Advantage. Medicare beneficiaries who qualify for Medicaid for the aged, blind and disabled (ABD) can receive coverage for cost sharing and services Medicare doesn’t cover.
In Alaska, Medicaid ABD covers up to $1,150 a year in dental benefits for enrollees 21 or older. Medicaid covers preventive and restorative dental care, including cleanings, exams, crowns, root canals, and dentures. This benefit begins on July 1 and ends on June 30 of each year. Seniors may be able to combine two years of benefits to pay for expensive services like dentures.
Emergency dental care doesn’t count toward this limit – and is still covered after it is reached.
Medicaid ABD covers one vision exam by an optometrist or ophthalmologist each calendar year, and will also pay for one pair of approved eyeglasses per year.
In Alaska, Medicaid ABD is called Refused Cash Medicaid. Medicaid ABD enrollees may also receive the MSP.
Medicaid ABD typically does not cover Long-Term Services and Supports (LTSS). Applicants who need these services usually have to apply for that coverage separately.
Eligibility: The income limit is $1,455 a month if single and $2,155 a month if married.
Asset limits: The asset limit is $2,000 if single and $3,000 if married.
As the population ages, more Medicare beneficiaries will need long-term services and supports (LTSS) – or long-term care – which is mostly not covered by Medicare.
Medicaid can cover this needed service, but complex eligibility rules can make qualifying for benefits difficult. What’s more – eligibility rules vary significantly from state to state. Here’s how Alaska regulates Medicaid LTSS eligibility.
Income limit: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying). However, nursing home enrollees in Alaska can only keep $200 of this income as a personal needs allowance, along with money to pay for Medicare and health insurance premiums. Their remaining income must be paid toward their care.
Asset limit: The asset limit is $2,000 if single and $4,000 if married (and both spouses are applying). If one spouse doesn’t have Medicaid, spousal impoverishment rules allow the non-applying spouse to keep up to $128,640.
Certain items don’t count toward the asset limit. For example, many household effects, family heirlooms, some prepaid burial arrangements, and a car are excluded. In Alaska, nursing home enrollees can’t have more than $595,000 in home equity.
Every state’s Medicaid program covers community-based long-term care, which is provided in an enrollee’s home, adult day care center, or another “community” setting. Programs offering this type of care are called Home and Community Based Services (HCBS) waivers because recipients continue living in the community, rather than entering a nursing home.
Income eligibility: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying).
Despite this income limit, Medicaid programs usually require HCBS recipients to pay a certain amount of their income each month toward their care. If this payment is too high, enrollees may not have enough money left to pay for living expenses. In Alaska, HCBS enrollees can keep $1,656 of their income as a personal needs allowance, which is a more than allowed in many other states.
Asset limits: The asset limit is $2,000 if single and $4,000 if married (and both spouses are applying). If one spouse doesn’t need Medicaid, spousal impoverishment rules allow the non-applying spouse to keep up to $128,640.
Some assets – such as many household effects, family heirlooms, some prepaid burial arrangements, and one car – do not count toward the asset limit. HCBS enrollees also are not allowed to have more than $595,000 in home equity.
Eligibility rules for Medicaid LTSS programs differ from other Medicaid benefits when only one spouse is applying. When this occurs, only the applying spouse’s income is counted. This is an exception to how Medicaid programs normally look at income limits: Usually, the income of both spouses is counted.
Spousal impoverishment protections allow the “community spouse” (the spouse who is not applying for long-term care coverage) of Medicaid LTSS recipients to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s monthly income. (Nursing home enrollees would pay nearly all of their income toward their care, which is why it is helpful for couples to be able to transfer a portion of that income to the spouse who doesn’t have Medicaid.)
In Alaska in 2020, spousal impoverishment rules allow community spouses to keep:
Applicants who have income above the eligibility limit for Medicaid ABD / Refused Cash Medicaid or long-term care benefits can qualify for those programs by depositing income into a Qualified Income Trust, which is also called a “Miller Trust.”
This brochure has more information about using a Miller Trust to qualify for Medicaid in Alaska.
Federal law requires states to restrict eligibility for Medicaid nursing home benefits and HCBS to applicants with a home equity under a specified amount. States set this home equity limit by choosing between a federal minimum of $595,000 and maximum of $893,000 in 2020.
In 2020, Alaska limits Medicaid eligibility for HCBS and nursing home care to those who have a home equity interest of $595,000 or less. Applicants with more home equity than this not eligible for Medicaid LTSS coverage.
Because long-term care is expensive, many applicants consider transferring their assets to someone else to qualify for Medicaid LTSS benefits. As a deterrent, federal law requires states to penalize asset transfers or gifts with a period of ineligibility for nursing home care, and gives them the option of having a penalty period for HCBS. Medicaid won’t cover an enrollee’s LTSS during this period.
Alaska has chosen to have an asset transfer penalty for nursing home benefits and HCBS. This penalty is based on a 60-month look-back period when asset transfers and gifts aren’t allowed. This penalty period is determined by dividing the amount transferred by the average private cost for nursing home care (which is $10,000 a month in Anchorage, but varies on other parts of the state).
Each state Medicaid program is required to recover what it paid for long-term care and associated medical costs while an enrollee was 55 or older. States can also all Medicaid benefits paid on behalf of those enrollees (rather than limiting estate recovery to LTSS-related expenses). This is called estate recovery.
Alaska chooses to only pursue estate recover from recipients of Medicaid-covered nursing home care or HCBS in this age range, but may also recover from enrollees under 55 who were institutionalized.
Usually, only an enrollee’s probate estate is subject to estate recovery in Alaska, meaning that things like life estates, living trusts, and retirement or bank accounts with “transfer-on-death” provisions are exempt.
Alaska generally does not try to collect if an enrollee is survived by their spouse, or a child who is under 21 or disabled. The state may choose not to pursue estate recovery from certain American Indians or Alaska Natives.
Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery with benefits paid after December 31, 2009. In Alaska, Medicaid will not try to recover what it paid for MSP benefits after that date – but could recover MSP benefits paid beforehand if an enrollee received LTSS.
Free volunteer Medicare counseling is available through Alaska’s State Health Insurance Assistance Program (SHIP) at 907-269-3680 (in Anchorage) or 800-478-6065 (toll-free within Alaska).
SHIP representatives can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. They may also be able to offer referrals to local agencies for services like home care and long-term care. This website has more information about the SHIP in Alaska.
Elder law attorneys can help individuals plan for long-term care coverage. The National Academy of Elder Law Attorneys (NAELA) has a search feature you can use to find an elder attorney locally.
In Alaska, there are Aging and Disability Resource Centers (ADRCs) to help seniors and people with disabilities access long-term services and supports. This is a list of regional ADRC locations.
How do I apply for Medicaid in Alaska?
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare technical assistance contract at the Medicare Rights Center in New York City, where he represented clients with extensive Medicare claims and appeals. Josh also helped implement health insurance exchanges at the technology firm hCentive. He has also held consulting rules, including at Sachs Policy Group, where he worked with hospital, technology and insurer clients.