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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 Oklahoma’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 Oklahoma, 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: The asset limit for QMB, SLMB or QI is $7,860 if single and $11,800 if married. QDWI’s asset limit is $4,000 if living alone and $6,000 if living with others.
Medicare covers a great number of services – including hospitalization, physician services, and prescription drugs – but Original Medicare doesn’t cover important services like vision and dental benefits. Medicare can also leave its beneficiaries with large cost sharing expenses. Some beneficiaries – those whose incomes make them eligible for Medicaid – can receive coverage for additional services through Medicaid for the aged, blind and disabled (ABD).
In Oklahoma, Medicaid ABD only covers emergency dental extractions for adults. This means Medicaid will not pay for routine dental services. The Oklahoma Dental Association has a list of low-cost dental clinics in Oklahoma.
Medicaid ABD also generally does not cover routine vision care or eyeglasses in Oklahoma. This means the principal benefit Medicaid offers (besides long-term care coverage) is payment for Medicare cost sharing expenses. In some states, Medicaid also covers home health care and medical supplies that Medicare doesn’t pay for.
Income eligibility: The income limit is $1,063 a month if single and $1,437 a month if married.
Asset limits: The asset limit is $2,000 if single and $3,000 if married.
Oklahoma does not have a Medicaid spend-down program, which allows individuals who are over-income to subtract medical expenses from income that is counted toward the eligibility limit. As a result, applicants are not able to qualify for Medicaid ABD if their incomes are higher than the limit for that program.
However, applicants with incomes too high to qualify for Medicaid long-term care benefits can become eligible for those services by depositing income into a Miller Trust (described below).
Medicare beneficiaries who are enrolled in Medicaid, an MSP, or Supplemental Security Income (SSI) also receive Extra Help. This is a federal program that lowers the prescription costs under Medicare Part D. You can also apply for Extra Help through the Social Security Administration if you don’t receive it automatically. The income limit is $1,615 a month for individuals and $2,175 for married couples, and the asset limit is $14,610 for singles and $29,160 if spouses.
Medicare beneficiaries increasingly rely on long-term services and supports (LTSS) – or long-term care – which is mostly not covered by Medicare. 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 further as the population ages.
In past decades, most Americans received long-term care in nursing homes. Even though many beneficiaries prefer to receive this care at home, their medical conditions, living situation or finances can make nursing home care a better option. Medicaid covers nursing home benefits for an unlimited number of enrollees in each state.
Income limits: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying).
However, this income limit doesn’t mean an applicant can keep all of this income up to the limit. Nursing home enrollees must pay nearly their entire income toward their care, other than a small personal needs allowance (of $50 a month) and the cost of health insurance premiums (such as Medicare Part B and Medigap).
When only one spouse needs Medicaid, the income limit for single applicants is used – and only the applicant’s income is counted.
Assets limits: The asset limit is $2,000 per applicant. If only one spouse needs Medicaid, federal rules allow the other spouse to keep up to $126,640.
Certain assets are never counted, including many household effects, family heirlooms, certain prepaid burial arrangements, and one car. Nursing home enrollees can’t have more than $595,000 in home equity.
Every state’s Medicaid program pays for community based long-term care, which is provided in an enrollee’s home, adult day care center, assisted living facility, or another community location. Programs that cover this form of long-term care are called Home and Community Based Services (HCBS) waivers.
States do not have to cover HCBS benefits, but every state has chosen to cover this service. However, because HCBS benefits are expensive enough to impact state budgets, many states use waiting lists for these programs. This could mean an applicant has to receive care in a nursing home while waiting for a spot in an HCBS program.
Income limits: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying).
This income limit doesn’t mean applicants are allowed to keep all of their income up to this level. In Oklahoma, HCBS recipients can keep a personal needs allowance (which is $1,101 as of 2018), but nearly all their remaining income must be paid toward their care.
When only one spouse needs Medicaid, the income limit for single applicants is used – and usually only the applicant’s income is counted.
Assets limits: The asset limit is $2,000 per applicant. If only one spouse needs Medicaid, federal spousal impoverishment rules allow the other spouse to keep up to $126,800. HCBS enrollees are also not allowed to have more than $595,000 in home equity.
Oklahoma does not allow individuals with incomes above the eligibility limit for Medicaid long-term care to pay the income they have toward their care, and have Medicaid pay the rest, and is known as an “income cap state.”
But if their income is less than the cost of nursing home care ($5,420 a month in 2020), they can become eligible for Medicaid nursing home or HCBS benefits by depositing income into a Qualified Income Trust, which is also called a “Miller Trust.”
Income is not counted toward the Medicaid eligibility limit if it is placed in the trust each month.
Eligibility rules for Medicaid long-term care benefits differ from other Medicaid programs 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 is applying.
Spousal impoverishment rules allow the spouses of Medicaid LTSS recipients (i.e., the non-applying spouses) to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s monthly income, along with resource and housing allowances. These rules apply when one spouse is receiving Medicaid coverage for LTSS, and the other spouse doesn’t have Medicaid.
In Oklahoma in 2020, these 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.
Oklahoma uses the federal minimum home equity limit – meaning applicants with more than $595,000 in home equity are not eligible for Medicaid nursing home care or HCBS.
Because long-term care is expensive, individuals can have an incentive to give away or transfer assets to make themselves eligible for Medicaid nursing home or HCBS benefits. To curb these asset transfers, federal law requires states to have a penalty period for nursing home applicants who give away or transfer assets for below their value. States can also have a penalty period for HCBS. Medicaid will not pay for LTSS during this period.
Oklahoma has an asset transfer penalty for both nursing home care and HCBS. This penalty is based on a 60-month lookback period. The penalty period is calculated by dividing the value of asset transfers and gifts made during the lookback period by the cost of nursing home care (which is about $178 per day in Oklahoma in 2020).
A state’s Medicaid agency is required to recover what it paid for LTSS and related medical costs beginning at the age of 55. States have the option to also recover costs for enrollees in this age group that are unrelated to LTSS, and to recover from enrollees who did not receive LTSS.
Oklahoma has chosen to recover what it paid for all Medicaid benefits beginning at the age of 55.
When Medicaid coverage was administered by a Managed Care Organization (MCO), the state will attempt to recover what it paid the MCO. That means the estate recovery amount could be more (or less) than the actual cost of Medicaid services received.
Oklahoma will grant an exemption to estate recovery in cases where recovering from an estate would cause undue hardship to the inheritor.
Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery starting with benefits paid after December 31, 2009, but in Oklahoma, Medicaid would attempt to recover the cost of MSP benefits paid through that date.
Free volunteer Medicare counseling is available by contacting the Senior Health Insurance Counseling Program (SHIP). You can reach this program by calling 800-763-2828.
The SHIP 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 provide referrals for home care agencies or long-term care services. This website has more information about the SHIP in Oklahoma.
You can also hire an elder law attorney to help you plan for Medicaid long-term care benefits. Use this search feature from the National Academy of Elder Law Attorneys (NAELA) to locate an elder attorney in your area.
Oklahoma’s Medicaid program is administered by the Oklahoma Health Care Authority (OHCA). You can apply for Medicaid or an MSP using this website or by visiting a local county Department of Human Services (DHS) office.
You will be interviewed and undergo a needs assessment if you apply for Medicaid long-term care benefits. But many states no longer require an interview for Medicaid ABD applicants, and they can’t require one for the 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, 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.
