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The state where you lives makes a difference in how much you pay as a Medicare beneficiary. This page describes resources available to help eligible Indiana residents for Medicare premiums and cost-sharing. It also provides an overview of Medicaid programs (for qualifying applicants) to 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 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.
Indiana has slightly higher income limits for MSPs than many other states. The federally established income limits for QMB, SLMB and QI are 100, 120 and 135 percent of the federal poverty level, respectively. In Indiana, those limits are 150 percent of the poverty level for QMB, 170 percent for SLMB, and 185 percent for QI.
MSP asset limits: Indiana uses the federal asset limits for QMB, SLMB and QI – which are $7,860 if single and $11,800 if married. The QDWI asset limit is $4,000 if single and $6,000 if living with others.
Medicare covers many services – including hospitalization, physician services, and prescription drugs – but can leave enrollees with significant out-of-pocket costs (i.e., deductibles, co-pays, and coinsurance). Original Medicare also does not cover important services like vision and dental benefits, although Medicare Advantage plans sometimes do offer this coverage.
[mro_survey align ="right"]Medicare enrollees with low incomes and assets can receive coverage for Medicare cost sharing and additional services like vision and dental care if they’re enrolled in Medicaid benefits for the aged, blind and disabled (ABD).
Medicaid is called Hoosier Care Connect in Indiana.
Income eligibility: The income limit is $1,063 a month if single and $1,437 a month if married.
Asset limits: The asset limit is $2,000 if single and $3,000 if married.
Medicare beneficiaries who are enrolled in Medicaid, an MSP, or Supplemental Security Income (SSI) also receive Extra Help – a federal program that dramatically lowers prescription drug costs under Medicare Part D. Individuals who don’t receive Extra Help automatically can apply for it through the Social Security Administration, in which case the income limit is $1,615 a month for single applicants and $2,175 a month for married couples. Applicants must also satisfy an asset limit – which is $14,610 for single applicants and $29,160 for married couples.
Medicare beneficiaries increasingly rely on long-term services and supports (LTSS) – or long-term care – which is generally not covered by Medicare. In fact, 20 percent of Medicare beneficiaries who lived at home received some assistance with LTSS in 2015, and more seniors will need those services as the population ages. Medicaid may fill this gap in Medicare coverage for long-term care, but its complex eligibility rules — which vary from state to state — can be hard to navigate.
Income limits: The income limit is $2,349 a month per person and $4,698 a month if married (and both spouses are applying). When only one spouse needs nursing home benefits, the income limit for single applicants is used; typically only income received by the applying spouse is counted toward that limit.
Despite an income limit, Indiana nursing home enrollees aren’t allowed to keep most of this income. While they can keep money to pay for health insurance premiums (such as Medicare Part B, Medicare Advantage and Medigap) and a $52 personal needs allowance, the rest of income the enrollee’s income must go to the nursing home.
Assets limits: The asset limit is $2,000 if single and $3,000 if married (and both spouses are applying). If only one spouse has Medicaid, federal rules let the other spouse can keep as much as $128,640. (Note that some assets are not counted toward the limit; examples of excluded assets include household effects, family heirlooms, certain prepaid burial arrangements, and one car.) Applicants are also not allowed to have more than $595,000 in home equity.
Every state’s Medicaid program covers community-based long-term care services, which are offered in an enrollee’s home, adult day care center, assisted living facility, or similar setting. Medicaid programs offering this care are called Home and Community Based Services (HCBS) waivers because recipients receive benefits while living at home rather than in a nursing home.
Income limits: The income limit is $2,349 a month per person and $4,698 a month if married (and both spouses are applying). If 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.
Unlike most states, Indiana allows enrollees to keep all of their income up to this limit as a personal needs allowance.
Asset limits: The asset limit for Medicaid nursing home coverage is $2,000 if single and $3,000 if married (and both spouses are applying). If only one spouse has Medicaid, federal rules let the other spouse keep up to $128,640.
For Medicaid LTSS programs, only the applying spouse’s income is factored into eligibility limits. With other Medicaid benefits, the income of both spouses is counted no matter who needs the coverage.
Spousal impoverishment rules allow spouses of Medicaid LTSS recipients to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s monthly income if the community spouse doesn’t have Medicaid coverage. This rule is helpful for couples when one spouse needs nursing home care but the other still lives at home, because the LTSS-covered spouse would otherwise have to pay nearly all their income toward their care.
In Indiana in 2020, the community spouse can keep:
The Indiana Medicaid spend-down does not cover LTSS benefits, but applicants can qualify for those services by depositing income each month into a Qualified Income Trust, which is also called a “Miller Trust.” Even though it is deposited in the Miller Trust beforehand, nursing home enrollees have to pay nearly all their income toward their care. However, Indiana allows HCBS recipients to retain all their income up to the eligibility limit (of $2,349 a month per person) as a personal needs allowance to pay for living and health-related expenses.
Medicaid applicants in Indiana can use a QIT to qualify for Medicaid nursing home or HCBS benefits, but not for regular Medicaid ABD benefits (if they don’t also need LTSS coverage).
Federal law requires states to restrict eligibility for Medicaid nursing home and HCBS to applicants with a home equity interest below a specific dollar amount. In 2020, each state sets its limit within the federal limits (minimum of $595,000 and maximum of $893,000).
Indiana requires Medicaid LTSS applicants to have a home equity interest of $595,000 or less.
Because long-term care is expensive, individuals may consider giving away or transferring assets to meet eligibility requirements for Medicaid LTSS benefits. To discourage asset transfers, federal law requires states to define a penalty period for nursing home care applicants who give away or transfer assets for less than market value. States can also have a penalty period for HCBS. Medicaid will not pay for LTSS during this period.
Indiana chooses to have a penalty period for nursing home benefits and HCBS. This penalty is based on a 60-month lookback period when asset transfers and gifts aren’t allowed. The penalty’s length is calculated by dividing the amount of money transferred or given away by the monthly private pay cost of nursing home care (which is $6,681 in 2020).
These regulations govern the Medicaid lookback and penalty periods in Indiana.
Medicaid agencies have to attempt to recover or “claw back” what they paid for LTSS and related medical costs while enrollees were 55 or older. States can choose to claw back payments for all Medicaid benefits received beginning at that age, and to recover from enrollees who didn’t receive LTSS.
Indiana chooses to recover from any enrollee 55 or older who receives Medicaid. The state may also recover from estates of enrollees younger than 55 who were permanently institutionalized in a nursing home, intermediate care facility for individuals with intellectual and developmental disabilities (IDD), or other institutional setting.
When Medicaid coverage was administered by a Managed Care Organization (MCO) (i.e., a private insurer with whom the state contracts to administer Medicaid benefits), Indiana will attempt to recover what it paid the MCO. This means the state could try to recover more (or less) than the actual cost of Medicaid services received.
Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery starting with benefits paid after December 31, 2009, but Medicaid will attempt to recover the cost of MSP benefits received that date.
No-charge Medicare counseling is available by contacting Indiana’s State Health Insurance Assistance Program (SHIP) at 1-800-452-4800.
SHIPs can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. SHIP counselors may also be able to offer referrals to local agencies for services like home care and long-term care. The Indiana SHIP’s website includes a list of its offices by county.
Elder law attorneys can help individuals plan for long-term care needs. You can use the National Academy of Elder Law Attorneys (NAELA) search feature to find an elder attorney in your area.
Indiana’s Long Term Care Ombudsman investigates complaints about long-term care facilities. Its phone number is 800-622-4484. This website includes a list of regional offices for the Ombudsman Program.
The Indiana Family and Social Services Administration (FSSA) administers Indiana’s Medicaid program. You can apply for Medicaid ABD or the MSP using this website.
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 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 with hospital, insurer and technology clients.