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Financial help for Maryland Medicare enrollees

Medicaid estate recovery in Maryland applies to Medicaid expansion enrollees, and can amount to more (or less) than the cost of care the person received

Josh Schultz // October 4, 2020

Reviewed by our health policy panel.

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 Maryland’s regulations and policies are likely to affect your bottom line as a Medicare beneficiary. It also details long-term care coverage that may be available through Maryland’s Medicaid program.

Does Maryland help with my Medicare premiums?

Many Medicare beneficiaries who find it difficult to pay for coverage are eligible for help through a Medicare Savings Program (MSP).  In Maryland, these programs pay for Medicare Part B premiums, Medicare cost-sharing, and – sometimes – Part A premiums.

  • Qualified Medicare Beneficiary (QMB): The income limit is $1,063 a month if single and $1,437 a month if married. QMB pays for Part A and B cost sharing, Part B premiums, and Part A premiums if the beneficiary owes them.
  • Specified Low-Income Medicare Beneficiary (SLMB) and SLMB II:  The income limit is from QMB levels up to $1,436 a month if single or $1,943 a month if married. These programs pay for Part B premiums.

MSP asset limits: The asset limit is $7,860 if single and $11,800 if married.

The income and asset limits for QMB and SLMB vary based on an applicant’s marital status. However, eligibility rules for QDWI, Medicaid for the aged, blind and disabled, and Long Term Services and Supports vary based on the number of household members.

Who's eligible for Medicaid ABD in Maryland?

Medicare covers a great number services – including hospitalization, physician services, and prescription drugs – but Original Medicare doesn’t cover important services like vision and dental benefits. Some beneficiaries – those whose incomes make them eligible for Medicaid – can receive coverage for Medicare cost sharing and some services only Medicaid covers if they’re enrolled in Medical Assistance for the Aged, Blind and Disabled (MA-ABD) in Maryland.

But in Maryland, the Medicaid program doesn’t cover any dental care for adults. This website has a list of dental clinics in Maryland for individuals with low incomes.

Medicaid does cover one eye exam every two years, but it does not pay for eyeglasses.

Income eligibility: The income limit is $350 a month if single and $392 a month if married.*

Asset limits: The asset limit is $2,500 if single and $3,000 if married.

*The income limit for MA-ABD is unusually low. But Supplemental Security Income (SSI) enrollees automatically receive Medicaid ABD in Maryland – which has the effect of increasing the income limit for Medicaid.

In 2020, individuals who are 65 or older, blind or disabled can qualify for SSI with incomes up to $783 a month for individuals and $1,175 a month for married spouses who live together, and assets below $2,000 for singles and $3,000 for spouses. (SSI is an income support benefit that provides most enrollees with monthly cash payments equal to the program’s income limit.)

The asset limit for SSI is slightly lower than the limit for MA-ABD for single applicants ($2,000 for SSI vs. $2,500 for MA-ABD). But SSI and MA-ABD asset limits are the same for married applicants ($3,000).

Maryland Medicaid spend-down for Medicaid ABD and long-term care

Applicants who are over-income for MA-ABD and SSI can enroll in the Medicaid spend-down program, which allows applicants to qualify for Medicaid by subtracting incurred medical expenses from their income that is counted toward eligibility limit.

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Medicaid calculates the portion of an enrollee’s monthly income above the program’s income limit; this amount is referred to as “excess income.” Enrollees activate their spend-down coverage by submitting medical bills equal to this amount.

Excess income – and the amount of medical expenses that must be submitted – are reduced by what an enrollee pays for health insurance premiums (such as Medicare Part B or Medigap).

The Medicaid spend-down in Maryland covers Long Term Services and Supports (LTSS).

Income eligibility: The income limit is $350 a month if single and $391 a month if married.

Asset limits: The asset limit is $2,500 if single and $3,000 if married.

Federal assistance with prescription drug costs in Maryland

Medicare beneficiaries who also have Medicaid, an MSP, or Supplemental Security Income (SSI) are enrolled in Extra Help. This federal program lowers prescription costs under Medicare Part D. Beneficiaries can also apply for Extra Help through the Social Security Administration (SSA) if they don’t receive it automatically. The income limit is $1,615 a month for singles and $2,175 a month for couples, and the asset limit is $14,610 for individuals and $29,160 for spouses.

How does Maryland regulate long-term services and supports (LTSS)?

Medicare beneficiaries increasingly rely on long-term care, and the portion of seniors needing these services will keep rising as the population ages. However, long-term care is mostly not covered by Medicare. While Medicaid fills the gap in Medicare coverage for long-term care, its complex eligibility rules can make qualifying for benefits difficult. What’s more – eligibility rules vary significantly from state to state.

Medicaid nursing home coverage

Income limits: The applicant’s income cannot be higher than the cost of nursing home care. However, this doesn’t mean nursing home enrollees can keep all of their income up to the cost of care. Enrollees must pay nearly all their income each month to their nursing home, other than a small personal needs allowance (of $82 a 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 can keep up to $128,640.

Certain assets are never counted, including many household effects, family heirlooms, certain prepaid burial arrangements, and one car.

In Maryland, nursing home enrollees can’t have more than $595,000 in home equity.

Home and Community Based Services (HCBS) waivers

All state Medicaid programs cover community-based long-term care, which is provided at home or in a community setting. Programs that pay for this care are called Home and Community Based Services (HCBS) waivers because enrollees 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 Medicaid, the income limit for single applicants applies and the state usually consider the applying spouse’s income only.

Asset 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 can keep up to $128,640; this limit excludes certain assets.

HCBS enrollees are not allowed to have more than $595,000 in home equity.

Spousal impoverishment protections in Maryland

Eligibility rules for Medicaid LTSS programs differ from those for other Medicaid benefits. Normally with Medicaid benefits, the income of both spouses is counted regardless of who is applying. For LTSS, only the applying spouse’s income is counted.

If the spouse of a Medicaid nursing home or HCBS recipient doesn’t have Medicaid, spousal impoverishment rules allow them to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s income.

In Maryland in 2020, spousal impoverishment rules allow the “community spouse” to keep:

  • An MMMNA that is between $2,155 and $3,216 per month.
  • A Community Spouse Resource Allowance (CSRA) that is up to $128,640.
  • A housing allowance of up to $646.50 a month.

Permitted home equity interest in Maryland

Federal law requires states to limit eligibility for Medicaid nursing home and HCBS to applicants with a home equity interest below a specific dollar amount. In 2020, states set this home equity level based on a federal minimum of $595,000 and maximum of $893,000.

Maryland uses the most restrictive limit on home equity. Accordingly, Maryland Medicaid LTSS applicants can’t have more than $595,000 in home equity.

Penalties for transferring assets in Maryland

Given the significant cost of long-term care, individuals sometimes consider transferring assets to meet eligibility requirements for Medicaid LTSS benefits. As a disincentive to asset transfers, federal law requires states to have a penalty period for Medicaid nursing home applicants who give away or transfer assets at below-market value. States can choose to also have an asset transfer penalty for HCBS.

Maryland has chosen to have a penalty period that applies to both nursing home care and HCBS. The state looks back for 60 months for asset transfers and gifts. If transfers are seen, the state imposes a penalty period, which is determined by dividing the amount of money transferred or given away by the monthly cost of nursing home care (this is $9,673 in Maryland in 2020).

Medicaid will not pay for LTSS during the penalty period.

Estate recovery in Maryland

State Medicaid agencies have to try to recover what they paid for long-term care related costs while an enrollee was 55 or older. States can choose to also recover their payments for all other Medicaid benefits. This is called estate recovery.

Maryland has chosen to recover the cost of all Medicaid benefits received beginning at age 55 (rather than limiting recoveries to the recipients of LTSS). This means Medicaid expansion enrollees are also subject to estate recovery in Maryland.

When a deceased enrollee’s Medicaid coverage was administered by a Managed Care Organization (MCO) (i.e., a private insurer with whom the state contracts to administer Medicaid benefits), the state will attempt to recover what it paid that MCO. That means the estate recovery amount could differ from the actual cost of Medicaid services received (state Medicaid programs pay managed care insurers a certain amount per enrollee; some enrollees use medical services amounting to far less than this amount, while others use far more).

Maryland will delay its estate recovery for enrollees who are survived by their spouse or a child who is under 21 or disabled. Estate recovery would occur once the spouse died, or the child turned 21 or was no longer considered disabled.

Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery starting with benefits paid after December 31, 2009, but Medicaid will try to recover what it paid MSP benefits through that date.

Where can Medicare beneficiaries get help in Maryland?

Maryland Senior Health Insurance Program (SHIP)

Free volunteer Medicare counseling is available by contacting the Maryland Senior Health Insurance Program (SHIP). This is a list of phone numbers for the SHIP office in each county.

Maryland SHIP offices 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.

Elder Law Attorneys

Elder law attorneys help individuals plan for Medicaid long-term care benefits. You can use this National Academy of Elder Law Attorneys (NAELA) search feature to find a local elder attorney.

HealthCare Access Maryland

You may be able to receive local help from HealthCare Access Maryland, a non-profit organization dedicated to connecting Maryland residents to insurance and health care. The organization’s website has information about the services it offers.

Where can I apply for Medicaid in Maryland?

Maryland’s Medicaid program is administered by the Department of Human Services (DHS). You can apply for Medicaid ABD or a Medicare Savings Program using this website or by visiting a local Department of Social Services.

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, 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 rules, including at Sachs Policy Group, where he worked with insurer, hospital and technology clients.

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