- Medicare beneficiaries who live in Georgia may qualify for help affording Medicare coverage through a Medicare Savings Program.
- Applicants can qualify for Medicaid for the aged, blind and disabled with incomes up to $783 a month if single and $1,175 a month if married in Georgia.
- Applicants whose incomes are too high for Medicaid for the aged, blind and disabled can enroll in the Medicaid spend-down program.
- Medicare beneficiaries with low incomes may be eligible for federal assistance in Georgia.
- In Georgia, applicants can qualify for Medicaid nursing home coverage with incomes up to $2,349 a month if single and $4,698 a month if married.
- Applicants can receive Medicaid HCBS if they have incomes up to $2,349 a month if single and $4,698 a month if married.
- In Georgia in 2020, spousal impoverishment rules allow spouses of Medicaid enrollees to keep an allowance of between $2,155 and $3,216 per month.
- Applicants for Medicaid nursing home care or HCBS can’t have more than $595,000 in home equity.
- There is an asset transfer penalty for nursing home care and HCBS in Georgia.
- Georgia pursues estate recovery for enrollees who received Medicaid LTSS starting at the age of 55.
As a Medicare beneficiary, where you live – meaning your state of residence – can have a significant impact on the care that you receive and how you pay for that care during your “golden years.” This page explains how Georgia’s regulations and policies are likely to affect your bottom line.
Does Georgia help with my Medicare premiums?
Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program (MSP). In Washington, D.C., this program pays for Medicare Part B premiums, Medicare Part A and B cost-sharing, and – in some cases – Part A premiums.
- Qualified Medicare Beneficiary (QMB): The income limit is $1,064 a month if single or $1,437 a month if married. QMB pays for Part A and B cost sharing, Part B premiums, and – if an enrollee owes them – it also pays for their Part A premiums.
- Specified Low-income Medicare Beneficiary (SLMB): The income limit is from QMB levels up to $1,276 a month if single or $1,724 a month if married. SLMB pays for Part B premiums.
- Qualifying Individuals (QI): The income limit is from SLMB levels up to $1,436 a month if single or $1,940 a month if married. QI pays for Part B premiums.
MSP asset limits: Georgia uses the federal asset limit for QMB, SLMB and QI – which are $7,860 if single and $11,800 if married.
Who’s eligible for Medicaid for the aged, blind and disabled (ABD) in Georgia?
Medicare covers a great number of services – including hospitalization, physician services, and prescription drugs – but Medicare can leave enrollees with large out-of-pocket expenses (i.e. co-pays, deductibles and coinsurance). Furthermore, Original Medicare doesn’t cover important services like vision and dental care. Some beneficiaries – those with low incomes and assets – can receive coverage for Part A and B cost sharing and services Medicare doesn’t cover if they’re enrolled in Medicaid for the aged, blind and disabled (ABD).
Medicaid ABD also covers one pair of eyeglasses each year. A second pair of glasses may be covered due to significant changes in vision needs.
Medicaid ABD doesn’t automatically cover Long Term Services and Supports (LTSS) in most states. Those benefits require a different application and have different income limits than Medicaid ABD.
Income eligibility: The income limit is $783 a month if single and $1,175 a month if married.
Asset limits: The asset limit is $2,000 if single and $3,000 if married.
Applicants who are over-income for Medicaid ABD but have assets below the resource limit can enroll in the Medicaid spend-down program in Georgia. This program allows enrollees to subtract incurred medical expenses from their income so that it is below the eligibility limit.
When an applicant is approved for the spend-down, Medicaid calculates the portion of their monthly income above the income limit (known as “excess income”). Enrollees activate their spend-down coverage by showing they have medical bills equal to this excess income.
In Georgia, the Medicaid spend-down program does not cover long-term care. Applicants with incomes too high to qualify for LTSS can become eligible for them using a Miller Trust (described below).
Income eligibility: The income limit is $317 a month if single and $375 a month if married.
Asset limits: The asset limit is $2,000 if single and $3,000 if married.
Medicare beneficiaries enrolled in Medicaid, an MSP, or Supplemental Security Income (SSI) also get the Extra Help benefits. This program lowers drug costs under Medicare Part D. Enrollees can also apply for this benefit themselves through the Social Security Administration (SSA). The income limit is $1,615 a month for singles and $2,175 a month for couples, and assets are limited to $14,610 for individuals and $29,160 for spouses.
How does Georgia regulate long-term services and supports (LTSS)?
Medicare beneficiaries increasingly rely on long-term services and supports (LTSS) – or long-term care – which is mostly not covered by Medicare. In fact, 20 percent of Medicare beneficiaries living at home received some assistance with LTSS in 2015, and the portion of seniors needing those services will keep increasing as the population ages. Medicaid fills the gap in Medicare coverage for long-term care, but its complex eligibility rules can make qualifying for benefits difficult. What’s more – eligibility rules vary significantly from state to state.
Georgia uses a “special income limit” for Medicaid nursing home benefits and HCBS. This limit is 300 percent of the Supplemental Security Income (SSI) payment amount – or $2,349 a month per applicant.
Medicaid nursing home coverage
Most seniors used to receive long-term care in nursing homes. Today, many Americans receive those services in their homes. But medical conditions or living situations can make nursing home care a better choice for some.
Income limits: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying). When only one spouse needs Medicaid, the income limit for single applicants is used – and many states only count applying spouse’s income toward the eligibility limit.
Even though the income limit is $2,349 a month (if single), nursing home enrollees are not allowed to keep all of their income up to this limit. Instead, they pay all but a small portion of it to their nursing home, although they can keep a small personal needs allowance (of $70 each month) and money to pay for health insurance premiums (such as Medicare Part B and Medigap).
Assets limits: The asset limit is $2,000 if single and $3,000 if married (and both spouses are applying). If only one spouse needs Medicaid, the other spouse is allowed to keep up to $128,640.
Certain assets are never counted, including many household effects, family heirlooms, certain prepaid burial arrangements, and one car. Nursing home enrollees cannot have more than $595,000 in home equity.
Home and Community Based Services (HCBS) waivers
Medicaid programs in each state cover varying levels of community-based long-term care, which is provided at home, or in an adult day care center or assisted living facility. This Medicaid benefit is known as a Home and Community Based Services (HCBS) waiver because recipients don’t have to enter a nursing home.
Income limits: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying). When only one spouse needs HCBS and the other spouse doesn’t have Medicaid, the income limit for single applicants is used – and often only the applying spouse’s income is counted.
In Georgia, HCBS recipients can keep a personal needs allowance of $750 a month (as of 2018) to pay for health and living expenses. The remainder of their income must be paid toward their care.
Asset limits: The asset limit is $4,000 if single and $6,000 if married (and both spouses are applying). If only one spouse has Medicaid, the other spouse can keep up to $128,640. Applicants for HCBS must have less than $595,000 in home equity.
Qualifying for Medicaid LTSS with income above the eligibility limit in Georgia
The Medicaid spend-down in Georgia does not cover LTSS, which means applicants with incomes above the eligibility limit for Medicaid ABD can’t qualify for those benefits. But individuals with incomes higher than the limit for nursing home benefits or HCBS can qualify for those services by depositing income into a Qualified Income Trust, which is also called a “Miller Trust.”
As of 2018, once this income had been deposited into the Miller Trust, HCBS enrollees could withdraw up to $750 of it to pay for certain health and living expenses. But nursing home enrollees have to pay nearly their entire income toward care.
Spousal impoverishment protections in Georgia
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. With other Medicaid benefits, the income of both spouses is counted – regardless of who is applying.
Spousal impoverishment rules allow the spouses of Medicaid LTSS recipients to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s monthly income. These rules apply when one spouse receives Medicaid LTSS benefits, and the other spouse doesn’t have Medicaid.
Nursing home enrollees would pay nearly all of this income toward their care if they were unable to transfer a portion of it to their spouse.
In Georgia in 2020, these “community spouses” are allowed to keep:
- An MMMNA that is between $2,155 and $3,216 per month.
- A Community Spouse Resource Allowance (CSRA) that is between $25,728 and $128,640.
- A housing allowance of up to $646.50 a month.
Permitted home value in Georgia
Federal law requires states to restrict eligibility for Medicaid nursing home and HCBS to applicants with a home equity interest below a certain dollar amount. In 2020, states set their home equity limits based on a federal minimum home equity interest of $595,000 and a maximum of $893,000.
Georgia uses the lowest limit on home equity allowed under the law – and requires applicants for nursing home care or HCBS to have no more than $595,000 in home equity.
Penalties for transferring assets in Georgia
Because long-term care is expensive, individuals can have an incentive to give away or transfer assets to others so they can become eligible for Medicaid LTSS benefits. To curb this incentive, federal law requires states to have a penalty period for Medicaid nursing home applicants who give away or transfer assets for less than their value. States have the option to also use a penalty period for HCBS. Medicaid will not pay for an enrollee’s LTSS during this penalty period.
Georgia has chosen to have an asset transfer penalty for both nursing home care and HCBS. This penalty is based on a 5-year long lookback period during which asset transfers and gifts are prohibited. An individual’s penalty period is calculated by dividing the amount of money given away or transferred during the lookback period by the average cost of private pay nursing home care (this amount is $8,517 in 2020).
Estate recovery in Georgia
States are required to attempt to recover Medicaid’s payments for long-term care related costs beginning at the age of 55. States can choose to also recover all other Medicaid benefits. This is called estate recovery.
Georgia has chosen to only pursue estate recovery for enrollees who received long-term care benefits starting at age 55. But the state does also recover from some enrollees younger than this who were “permanently institutionalized.”
The state does not pursue estate recovery from estates valued at $25,000 or less.
Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery starting with benefits paid after December 31, 2009, but Medicaid may attempt to recover the cost of MSP benefits paid through that date. This could only occur in Georgia if an enrollee received LTSS.
Where can Medicare beneficiaries get help in Georgia?
Free volunteer Medicare counseling is available by contacting GeorgiaCares at 1-800-963-5337. This is Georgia’s State Health Insurance Assistance Program (SHIP) offered state’s Department of Human Services.
SHIPs 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 GeorgiaCares.
Elder Law Attorneys
Elder law attorneys can help individuals plan for Medicaid long-term care benefits. You can use the National Academy of Elder Law Attorneys (NAELA)’s search feature to find an elder attorney locally.
Georgia’s Long Term Care Ombudsman
Georgia’s Long Term Care Ombudsman helps beneficiaries understand their options for long-term care and investigates complaints made regarding a person who is receiving LTSS. Contact the Ombudsman Program by calling (866) 552-4464. More information is available on the program’s website.
How do I apply for Medicaid in Georgia?
The Georgia Department of Human Services (DHS) administers the Medicaid program in Georgia. You can apply for Medicaid ABD or an MSP using this website (and clicking the “Apply for Benefits” button on the lower right). Medicaid’s phone number is (877) 423-4746 in case you have questions about your application.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He has also held consulting roles, including at Sachs Policy Group, where he worked on Medicare and Medicaid related client projects.