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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 Nevada’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 Nevada, these programs pay for Medicare Part B premiums, Medicare Part A and B cost-sharing, and – in some cases – Part A premiums.
Nevada doesn’t count – or it ‘disregards’ – 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.
The income and asset limits for QMB, SLMB and QI are based on an applicant’s marital status, but the eligibility rules for Medicaid for the aged, blind and disabled and Long Term Services and Supports (LTSS) usually 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 if single and $11,800 if married.
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).
[mro_survey align ="right"]In Nevada, Medicaid ABD covers dental care for adults only in emergencies. Eye exams are covered every 12 months, but eyeglasses may not be covered for enrollees with routine vision problems.
Income eligibility: The income limit is $783 a month if single and $1,175 a month if married.
Asset limits: The asset limit is $2,000 if single and $3,000 if married.
Medicare beneficiaries can with limited incomes and resources may qualify for Extra Help – a federal program that reduces drug expenses under Medicare Part D. The income limit is $1,615 a month for individuals and $2,175 a month for married couples, and 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 must have a needs assessment.
Income limits: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying).
If only one spouse needs Medicaid, the income limit for single applicants is used (and usually only the applicant’s income is counted).
This income limit does not mean nursing home enrollees can keep all of their income up to the limit. Enrollees must pay nearly all their income each month toward their care, other than a small personal needs allowance (of $35 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 $4,000 if married (and both spouses are applying). If only one spouse has 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.
Every state’s Medicaid program covers community-based LTSS services. Programs that offer this type of care are called Home and Community Based Services (HCBS) waivers. Enrollees continue living in the community, and do not have to enter a nursing home.
The HCBS waiver programs available in Nevada vary based on age:
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 usually only the applicant’s income is counted).
Asset limits: The asset limit is $2,000 if single and $4,000 if married (and both spouses are applying). If only one spouse has Medicaid, federal rules let the other spouse keep up to $128,640.
Nevada does not have a Medicaid spend-down, but applicants with incomes above the income limit for Medicaid nursing home coverage or HCBS can qualify for those services by depositing income into a Qualified Income Trust or Miller Trust.
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. With other Medicaid benefits, the income of both spouses is counted regardless of who applies.
Spousal impoverishment rules allow the spouses of Medicaid LTSS recipients (i.e. the “non-applying spouse”) to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s income (along with a housing and resource allowance). These rules only apply if one spouse needs Medicaid coverage for LTSS, and the other spouse doesn’t receive any Medicaid benefits.
In Nevada in 2020, these community spouses can 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.
Nevada requires Medicaid LTSS applicants to have a home equity interest of $595,000 or less.
Because long-term care is expensive, individuals often have an incentive to give away or transfer assets to qualify for Medicaid. To curb these asset transfers, federal law requires states to have a penalty period for Medicaid nursing home applicants who give away or transfer assets for less than their value. States can also have a penalty period for HCBS. Medicaid will not pay for LTSS during this period.
Nevada has chosen to have a penalty period for nursing home care and HCBS. This penalty is based on a 60-month lookback period where asset transfers and gifts are prohibited. The penalty’s length is determined by dividing the amount of money transferred or given away by the monthly cost of nursing home care (which is about $8,839 in Nevada in 2020).
A state’s Medicaid agency is required to recover what it paid for long-term care related costs for enrollees who were 55 or older. The law allows states to also pursue estate recovery against enrollees who did not receive LTSS.
Nevada 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 people who received coverage for routine medical care or a hospitalization – and also recovers these costs from Medicaid expansion enrollees. Nevada also recovers from the estates of enrollees under age 55 who were institutionalized.
When coverage was administered by a Managed Care Organization (MCO) (i.e., 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. As a result, the estates of enrollees who didn’t use much care could be faced with a large estate recovery.
Nevada will not pursue estate recovery if a Medicaid beneficiary is survived either by a spouse or a child (who is under 21 or disabled). The state may also grant a hardship exemption from estate recovery under certain circumstances.
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 for MSP benefits through that date.
Free volunteer Medicare counseling is available by contacting the Nevada State Health and Insurance Assistance Program (SHIP) at 1-800-307-4444.
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.
The Medicaid program is administered by the Nevada Department of Welfare and Supportive Services (DWSS). Seniors and people with disabilities can apply for Medicaid using this website or by calling (800) 992-0900.
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 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.
