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The state where you lives makes a difference in how much you pay as a Medicare beneficiary. Here is how Minnesota’s regulations and policies are likely to affect your bottom line.
This page lists resources available to help eligible Minnesota residents pay for Medicare premiums and cost-sharing. It also provides an overview of Medicaid programs that help qualifying individuals 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). Minnesotans may qualify for help paying for Medicare Part A and B premiums as well as Medicare Part A and B cost-sharing.
MSP asset limits: The asset limit for QMB, SLMB and QI is $10,000 if single and $18,000 if married. QDWI’s asset limit is $4,000 if living alone and $6,000 if living with another person.
The income and asset limits for QMB, SLMB and QI vary based on an applicant’s marital status, but eligibility rules for QDWI, Medicaid for the aged, blind and disabled (ABD), and Long Term Services and Supports (LTSS) vary based on the number of household members (and not marital status).
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.
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 ABD.
In Minnesota, Medicaid ABD covers preventive dental services, including bitewings and cleanings, and restorative treatments. Medicaid also pays for eyeglasses every two years in Minnesota.
Medicaid ABD benefits don’t ordinarily cover Long Term Services and Supports (LTSS). Applicants seeking those services usually have to complete a separate application, undergo an assessment, and meet different income and asset limits.
Medicaid is called Medical Assistance (MA) in Minnesota.
Income eligibility: The income limit is $1,064 a month if single and $1,438 a month if married.
Asset limits: The asset limit is $3,000 if single and $6,000 if married.
Applicants who are over-income for Medicaid ABD benefits can by enrolling in the Medicaid spend-down. This program allows applicants to subtract incurred medical expenses from their income that is counted toward the Medicaid income limit.
Spend-down benefits are usually approved in six-month increments, with additional coverage requiring new medical expenses to be submitted.
The Medicaid spend-down in Minnesota covers Long Term Services and Supports (LTSS).
Income eligibility: The income limit is $862 a month if single and $1,161 a month if married.
Asset limits: The asset limit is $3,000 if single and $6,000 if married.
Medicare beneficiaries who also have Medicaid, an MSP, or Supplemental Security Income (SSI) receive Extra Help. This program lowers prescription drug costs under Medicare Part D.
Beneficiaries who don’t receive Extra Help automatically can apply for it through the Social Security Administration (SSA). 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).
Twenty percent of Medicare beneficiaries who lived at home received some assistance with LTSS in 2015, and the portion of seniors needing these services will rise as the population ages. And while Medicare beneficiaries increasingly rely on long-term care, it is generally not covered by Medicare. Medicaid provides long-term service and supports (LTSS), but its complex eligibility rules can make qualifying for benefits difficult.
Applicants who are seeking Medicaid long-term care benefits have to undergo a level of care assessment.
Most seniors used to receive long-term care in nursing homes. Today, more Americans receive long-term care in their homes. But some seniors have medical conditions that make nursing home care a better choice.
Income limits: The income limit is $1,064 a month if single and $1,438 a month if married and both spouses are applying.
When only one spouse needs Medicaid coverage for nursing home care, the income limit for single applicants is used and usually only the applying spouse’s income is counted.
However, this doesn’t mean nursing home enrollees can keep all of their income up to this limit. Enrollees must pay nearly all their income to their nursing home, other than a small personal needs allowance (of $104 a month) and money to pay for health insurance premiums (such as Medicare Part B and Medigap).
Assets limits: The asset limit is $3,000 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 — although not all assets are counted against this limit.
Applicants are not allowed to have more than $595,000 in home equity.
Every state’s Medicaid program covers community-based LTSS services for applicants who are still able to live safely at home with some assistance. Medicaid programs that pay for this type of support are called Home and Community Based Services (HCBS) waivers.
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, the income limit for single applicants is used and typically only the applicant’s income is counted.
Asset limits: The asset limit is $3,000 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 are not allowed to have more than $595,000 in home equity.
Spousal impoverishment rules allow the “community spouse” of a Medicaid LTSS beneficiary to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their spouse’s income. This provision is especially helpful for community spouses of nursing home enrollees, who have to pay nearly all their income toward their care.
In Minnesota in 2020, these spousal impoverishment rules allow community spouses to keep:
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.
Minnesota has chosen to use the most restrictive limit on home equity – meaning Medicaid LTSS beneficiaries can have no more than $595,000 in equity.
Because long-term care is expensive, individuals may consider transferring their assets to meet eligibility requirements for Medicaid LTSS. To curb these asset transfers, federal law requires states to have a penalty period for applicants for Medicaid nursing home care if they give away or transfer assets for less than their value. States can choose to also have a penalty period for HCBS.
Minnesota has chosen to have a penalty period that applies to both nursing home care and HCBS. The penalty period’s length is based on the value of the asset transfers or gifts made during the 60 months before receiving Medicaid. This penalty is calculated by dividing the value of what was transferred or given away by the monthly cost of nursing home care (which is $8,412 in Minnesota in 2020). Medicaid will not cover an applicant’s LTSS during this period.
State Medicaid agencies must attempt to recover what they paid long-term related costs while a beneficiary was 55 or older. States can also recover the cost of all other Medicaid benefits. This is called estate recovery.
Minnesota recovers from the estates of beneficiaries who received Medicaid coverage for LTSS beginning at the age of 55. The state also recovers what Medicaid spent on care for enrollees under 55 who were permanently institutionalized.
When Medicaid coverage is administered by a Managed Care Organization (MCO) (i.e., a private insurer contracted to provide Medicaid benefits), the state will attempt to recover what it paid that MCO. That means the estate recovery amount could be more or less than the actual cost of Medicaid services received.
Minnesota will delay its estate recovery if a beneficiary is survived by either their spouse or a child who is under 21 or disabled. If this happens, estate recovery would occur after the spouse’s death – or once the child turns 21 or is 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 may try to recover what it paid for MSP benefits through that date. In Minnesota, this could occur only if an enrollee received LTSS.
This Department of Human Services (DHS) brochure explains the estate recovery rules in Minnesota.
Free volunteer Medicare counseling is available by contacting the Senior LinkAge Line at 1-800-333-2433. Senior LinkAge Line can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. Counselors may also be able to offer referrals to local agencies for services like home care and long-term care. The Senior LinkAge Line’s website has more information about services it offers.
Elder law attorneys can advise individuals on Medicaid long-term care benefits. The National Academy of Elder Law Attorneys (NAELA) has a search feature to help beneficiaries connect with an elder attorney.
The Area Agencies on Aging (AAAs) in Minnesota can provide information about LTSS and help individuals plan for their long-term care needs. This is a list of AAAs throughout the state.
Medicaid in Minnesota is administered by the Department of Human Services (DHS). Separate websites have instructions for seniors and people with disabilities who need Medicaid or an MSP.
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 also represented Medicare clients. In addition to advocacy work, Josh helped implement 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.
