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As a Medicare beneficiary, the state where you live 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 Missouri’s regulations and policies are likely to affect your bottom line.
Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program (MSP). In Missouri, these programs pay for Medicare Part B premiums, Medicare Part A and B cost-sharing, and – in some cases – Part A premiums.
MSP asset limits: Arkansas uses the federal asset limits for QMB, SLMB and QI – which are $9,090 if single and $13,630 if married.
Income limits for MSPs and Medicaid ABD are significantly higher for applicants who are still working, because only a little less than half of income from employment is counted. This may allow some individuals with disabilities to return to work while maintaining benefit eligibility.
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 those additional services if they’re enrolled in Medicaid for the aged, blind and disabled (ABD).
In Missouri, Medicaid ABD covers routine dental care, including exams, cleanings, fillings and extractions.
The Medicaid program is called MO HealthNet in Missouri.
Income eligibility for the aged and disabled: The income limit is $963 a month if single and $1,297 a month if married. (Note that a higher income limit – $1,074 a month if single and $1,452 if married – applies to applicants who are blind.)
Asset limits: The asset limit is $5,301.85 if single and $10,603.70 if married. These asset limits are somewhat higher than in other states, where Medicaid enrollees often can’t have more than $2,000 if single and $3,000 if married.
Medicare beneficiaries who also have Medicaid, an MSP, or Supplemental Security Income (SSI) will receive Extra Help. This program lowers Medicare Part D prescription drug costs. When beneficiaries apply for this program themselves, the income limit is $1,843 a month for singles and $2,485 a month for couples. The asset limit is $16,660 for individuals and $33,240 for spouses.
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.
Applicants who are seeking Medicaid long-term care benefits have to undergo a level of care assessment.
Income limits: There is no income limit for nursing home coverage.
However, this doesn’t mean enrollees can keep all of this income. Nursing home enrollees must pay nearly all their income each month toward their care, other than a small personal needs allowance (of $50 a month) and money to pay for health insurance premiums (such as Medicare Part B and Medigap).
Assets limits: The asset limit is $5,301.85 if single and $10,603.70 if married (and both spouses are applying). If only one spouse has Medicaid, federal rules allow the other spouse to keep up to $148,620.
Certain assets are never counted, including many household effects, family heirlooms, certain prepaid burial arrangements, and one car.
Every state’s Medicaid program covers community-based long-term care. Programs that pay for this type of care are called Home and Community Based Services (HCBS) waivers. Recipients of these services can live in the community, rather than entering a nursing home.
Income limits: The income limit is $1,598 a month per applicant.
Asset limits: The asset limit is $5,301.85 per applicant. If only one spouse has Medicaid, federal rules let the other spouse keep up to $148,620.
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. (Normally with Medicaid benefits, the income of both spouses is counted – regardless of who is applying.)
If only one spouse needs Medicaid, spousal impoverishment rules allow the other spouse to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s income. This rule applies only to nursing home care and HCBS – and not other Medicaid benefits.
In Missouri in 2022, these spousal impoverishment rules allowed 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. States set these home equity levels based on a federal minimum of $688,000 and maximum of $1,033,000 in 2023.
Missouri requires Medicaid LTSS applicants to have a home equity interest of $688,000 or less.
Because long-term care is expensive, individuals can have an incentive to give away or transfer assets to make themselves eligible for Medicaid LTSS. To curb these asset transfers, federal law requires states to have a penalty period for applicants seeking Medicaid nursing home care who give away or transfer assets for less than their value. States can choose to also have a penalty period for HCBS. Medicaid will not pay for LTSS during the penalty period.
Missouri has chosen to have an asset transfer penalty for nursing home care and HCBS. This penalty period is based on a 60 month lookback period during which asset transfers and gifts are prohibited. The penalty’s length is calculated by dividing the amount of assets transferred or given away by the cost of nursing home care (and this is $6,894 a month in Missouri in 2023).
State Medicaid agencies have to attempt to recover what they paid for long-term care related expenses enrollees received beginning at age 55. States can choose to also pursue estate recovery from costs that aren’t long-term care related, and for enrollees who did not receive LTSS.
As of 2007, Missouri had chosen to pursue estate recovery for the cost of all Medicaid benefits (and not only recover from recipients of LTSS). So Missouri Medicaid (MO HealthNet) beneficiaries who are age 55 or older are subject to Medicaid estate recovery, even if they don’t use LTSS.
When Medicaid coverage was administered by a Managed Care Organization (MCO) (ie, a private insurer with which the state contracts to administer Medicaid benefits), the state will attempt to recover what it paid the MCO. That means the estate recovery amount could differ from the actual cost of Medicaid services received.
Missouri will not pursue estate recovery for enrollees who are survived by a spouse or a child who is under 21 or disabled. The state may also grant other hardship exemptions from estate recovery under specific circumstances.
Missouri State Health Insurance Assistance Program
Free volunteer Medicare counseling is available by contacting the Missouri State Health Insurance Assistance Program at 800-390-3330. The SHIP program in Missouri is called “CLAIM.”
The SHIP 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 SHIP’s website has more information on services it offers.
Elder Law Attorneys
Elder law attorneys can help individuals plan for Medicaid long-term care benefits. You can use this National Academy of Elder Law Attorneys (NAELA) search feature to find an elder attorney locally.
Missouri Area Agencies on Aging (AAAs)
Medicare beneficiaries in Missouri can also receive help from Area Agencies on Aging (AAAs). These organizations can provide information about services that help with aging or living with a disability, and assist with planning for long-term care needs. Here is a list of AAAs in Missouri.
Medicaid is administered by the Department of Social Services in Missouri. You can use this website to apply for Medicaid ABD or an MSP in Missouri.