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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 Nebraska’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 Nebraska, these programs pay for Medicare Part B premiums, Medicare Part A and B cost-sharing, and – in some cases – Part A premiums.
Nebraska doesn’t count the first $20 of an applicant’s unearned income (e.g. Social Security or pensions) when determining their eligibility for an MSP, Medicaid for the aged, blind and disabled, and Long Term Services and Supports (LTSS) programs. When an applicant has income from employment, less than half of that income is counted.
Income and asset limits for QMB, SLMB and QI always vary based on marital status, but in most states the eligibility limits for Medicaid for the aged, blind and disabled and Long Term Services and Supports (LTSS) vary based on the number of household members (but not marriage status).
MSP asset limits: The asset limit for QMB, SLMB and QI is $7,860 for singles and $11,800 for spouses. As noted above, QMB enrollees with assets below $4,000 for singles and $6,000 for spouses also qualify for full Medicaid benefits.
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).
Income eligibility: The income limit is $1,063 a month for a one person household or $1,437 for a two person household.
Asset limits: The asset limit is $4,000 for one person household and $6,000 for a two person household.
Applicants who are over-income for Medicaid benefits for the aged, blind and disabled in Nebraska can enroll in the Medicaid spend-down, which allows enrollees to subtract incurred medical expenses from their income that is counted toward the Medicaid income limit.
An applicant’s excess income is reduced by what they pay for health insurance premiums (such as Medicare Part B or Medigap).
The spend-down in Nebraska covers Long Term Services and Supports (LTSS).
Income eligibility: The income limit is $392 a month for both one and two person households (but this limit increases by $91 a month for each additional household member).
Asset limits: The asset limit is $4,000 if single and $6,000 if married.
Medicare beneficiaries who are enrolled in Medicaid, an MSP, or Supplemental Security Income (SSI) also receive Extra Help – a federal program that lowers prescription drug costs under Medicare Part D. When Medicare beneficiaries apply for this program themselves, the income limit is $1,615 a month for singles and $2,175 a month for couples. The asset limit is $14,610 for individuals and $29,160 for spouses.
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 who lived at home received some assistance with LTSS in 2015. Medicaid fills this 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.
Applicants who are seeking Medicaid long-term care benefits have to complete an assessment.
Income limits: The income limit is $1,063 a month if single and $1,437 a month if married. If only one spouse needs Medicaid, the income limit for single applicants is used (and usually only the applicant’s income is counted).
However, nursing home enrollees are not allowed to keep all of their income up to this limit. Enrollees must pay nearly all their income each month toward their care, other than a small personal needs allowance (of $60 a month) and money to pay for health insurance premiums (such as Medicare Part B and Medigap).
Assets limits: The asset limit is $4,000 if single and $6,000 if married. If only one spouse has Medicaid, the other spouse can keep up to $128,640.
Every state’s Medicaid program covers community-based LTSS services. Programs that cover this type of care are called Home and Community Based Services (HCBS) waivers. Enrollees continue living in the community, rather than entering a nursing home.
Income limits: The income limit is $1,063 a month for a one person household and $1,437 a month for a two person household.
If only one spouse needs Medicaid, the income limit for single applicants is used – and usually only the applicant’s income is counted.
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 has Medicaid, spousal impoverishment rules allow the other spouse to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s income (along with resource and housing allowances). These rules only apply when one spouse needs Medicaid nursing home care or HCBS, and the other spouse doesn’t receive any Medicaid benefits.
In Nebraska 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.
Nebraska requires applicants for Medicaid LTSS to have a home equity interest of $595,000 or less.
Because long-term care is expensive, individuals can have an incentive to give away or transfer assets so they qualify for Medicaid. To curb these asset transfers, federal law requires states to penalize applicants for Medicaid nursing home care who have given away or transferred assets for less than their value. States can choose to also have a penalty period for HCBS. Medicaid will not pay for LTSS during this period.
Nebraska has chosen to have an asset transfer penalty for nursing home care and HCBS. This penalty is based on a 60 month lookback period, and is calculated by dividing the amount of money transferred or given away during that period by the monthly cost of nursing home care.
A state’s Medicaid agency is required to recover what it paid for long-term care related costs while a beneficiary was 55 or older. The law allows states to also pursue estate recovery against enrollees who did not receive LTSS. This is called estate recovery.
Nebraska has chosen to recover the cost of all Medicaid benefits received beginning at the age of 55. This means the state pursues estate recovery against enrollees in that age group who received Medicaid coverage for services like primary care or hospitalizations. And under the state’s current rules, Medicaid expansion enrollees who are 55 or older will also be subject to Medicaid estate recovery when they pass away (Medicaid expansion takes effect in Nebraska in October 2020). Nebraska will also recover from the estates of younger enrollees who were institutionalized.
When Medicaid coverage was administered by a Managed Care Organization (MCO) (i.e., a private insurer with which the state contracts to administer Medicaid coverage), the state will attempt to recover what it paid the MCO. This means the estate recovery amount could be more (or less) than the actual cost of Medicaid services received. As a result, estates of enrollees who use little care may be hit large estate recovery charges.
Nebraska may choose to not pursue estate recovery from enrollees who are survived by their spouse or a child who is under 21 or disabled. The state may also grant a hardship exemption from estate recovery for certain enrollees based on their specific situation.
Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery starting with benefits paid after December 31, 2009, but will attempt to recover the cost of MSP benefits paid through that date.
Free volunteer Medicare counseling is available by contacting the Nebraska State Health and Insurance Assistance Program (SHIP) at (800) 234-7119.
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 the services it offers.
Elder law attorneys can help individuals plan for Medicaid long-term care benefits. The National Academy of Elder Law Attorneys (NAELA) has a search feature beneficiaries can use to find an elder attorney locally.
In Nebraska, Area Agencies on Aging (AAAs) can provide information about services to help with aging or living with a disability, and can help with planning for long-term care. This is a list of AAAs in Nebraska.
The Medicaid program is administered by the Nebraska Department of Health and Human Services (DHHS). Seniors and people with disabilities can apply for Medicaid by visiting this website, calling (855) 632-7633 or visiting a local Public Assistance office.
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.