Key takeaways
- In Nevada, Medicare beneficiaries who struggle to afford their premiums may be eligible for help through a Medicare Savings Program (MSP).
- Applicants can qualify for Medicaid for the aged, blind and disabled with incomes up to $783 a month if single and $1,175 a month if married in Nevada.
- In Nevada, the income limit for Medicaid nursing home coverage is $2,349 a month if single and $4,698 a month if married (and both spouses are applying).
- The income limit for HCBS in Nevada is $2,349 a month if single and $4,698 a month if married (and both spouses are applying).
- Nevada does not have a Medicaid spend-down, but applicants with incomes too high for Medicaid nursing home care or HCBS can qualify for those services using a Miller Trust.
- In Nevada in 2020, spousal impoverishment rules allow spouses who don’t receive LTSS (and don’t have Medicaid) to keep an allowance that is $2,155 and $3,216 per month.
- Nevada requires applicants for Medicaid LTSS to have a home equity interest of $595,000 or less.
- Applicants for nursing home care or HCBS cannot transfer or give away assets for less than their value without incurring a penalty in Nevada.
- Nevada pursues estate recovery of all Medicaid benefits received beginning at the age of 55.
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.
Does Nevada help with my Medicare premiums?
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.
- 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 – if a beneficiary owes them – it also pays their Part A premiums.
- Specified Low Income Medicare Beneficiary (SLMB): The income limit is from QMB levels up to $1,276 a month if single and $1,724 a month if married. SLMB pays for Part B premiums.
- Qualified Individuals (QI): The income limit is from SLMB levels up to $1,436 a month if single and $1,940 a month if married. QI pays for Part B 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.
Who's eligible for Medicaid for the aged, blind and disabled in Nevada?
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 regular Medicaid benefits for the aged, blind and disabled (ABD).
[mro_survey align ="right"]Medicaid ABD doesn’t ordinarily cover Long Term Services and Supports (LTSS). Applicants usually have to apply for those services separately and undergo an assessment before receiving benefits.
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.
How does Nevada regulate long-term services and supports (LTSS)?
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.
Medicaid nursing home coverage
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.
Home and Community Based Services (HCBS) waiver
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:
- Age 65 or older – Home and Community Based Waiver for the Frail Elderly (HCBW-FE)
- Under 65 – Home and Community Based Waiver for Persons with Disabilities (HCBW-PD)
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.
Qualifying for Medicaid LTSS with income above the eligibility limit in Nevada
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.
Spousal impoverishment protections in Nevada
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:
- An MMMNA that is between $2,155 and $3,216 per month.
- A Community Spouse Resource Allowance (CSRA) of up to $128,640.
- A housing allowance of up to $646.50 a month.
Medicaid home equity limit in Nevada
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.
Penalties for transferring assets in Nevada
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).
Estate recovery in Nevada
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.
Where can Medicare beneficiaries get help in Nevada?
Nevada State Health and Insurance Assistance Program (SHIP)
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
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.
Where can I apply for Medicaid in Nevada?
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.