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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 Tennessee’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 Tennessee, 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 limits for QMB, SLMB and QI are $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, and can leave enrollees with significant cost sharing obligations. Some beneficiaries – those whose incomes make them eligible for Medicaid – can receive coverage for Medicare cost sharing and Medicaid-covered services if they’re enrolled in Medicaid benefits for the aged, blind and disabled (ABD).
Medicaid ABD also does not cover routine vision care in Tennessee.
Medicaid ABD benefits don’t ordinarily include Long Term Services and Supports (LTSS). In most states, applicants who need those services must submit a separate application, undergo an assessment, and meet different resource and income limits.
The Medicaid program is called TennCare in Tennessee.
Income eligibility: The income limit is $783 a month if single and $1,175 a month if married. (This is the same income limit as Supplemental Security Income.)
Asset limits: The asset limit is $2,000 if single and $3,000 if married.
Medicare beneficiaries who also have Medicaid, an MSP, or Supplemental Security Income (SSI) are enrolled in Extra Help. This federal program lowers prescription drug expenses under Part D. Individuals who don’t receive Extra Help automatically can apply for it themselves. The income limit is $1,615 a month for single applicants (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. Twenty percent of Medicare beneficiaries who lived at home received some assistance with LTSS in 2015 – and more seniors are expected to need these services as the population ages.
Income limits: The income limit is $2,349 a month per applicant. If only one spouse needs nursing home benefits, usually only that spouse’s income is counted toward this limit.
Note that nursing home enrollees are not allowed to keep all of their income up to this limit. Enrollees must pay nearly their entire income toward their care, other than a small personal needs allowance and money for health insurance premiums (such as Medicare Part B and Medigap).
Certain assets are never counted, including many household effects, family heirlooms, certain prepaid burial arrangements, and one car. An applicant can’t have more than $595,000 in home equity.
Every state’s Medicaid program covers community-based long-term care, which is provided at home, in an assisted living facility or another “community” setting. Programs offering this care are called Home and Community Based Services (HCBS) waivers, because recipients continue living in the community and don’t have to enter a nursing home. In Tennessee, HCBS enrollees must need a nursing home level of care or be “at risk” of entering a nursing home.
Income limits: The income limit is $2,349 a month per applicant. When only one spouse needs HCBS and the other spouse doesn’t have 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, spousal impoverishment rules allow the other spouse to keep up to $128,600.
The income limit for Medicaid LTSS programs in Tennessee is $2,349 a month (for single applicants). Individuals with higher incomes can qualify for Medicaid nursing home benefits or HCBS by depositing income into a Qualified Income Trust, which is also called a “Miller Trust.”
After income is placed in the Miller Trust, nursing home enrollees have to pay nearly all of it toward their care. However, Tennessee allows HCBS recipients to keep a personal needs allowance equal to the income limit to pay for health and living related expenses.
Eligibility rules for Medicaid LTSS programs differ from other Medicaid benefits when only one spouse is applying. When this occurs, only income received by the applying spouse is counted. With other Medicaid benefits, income of both spouses is counted – regardless of who is applying.
Spousal impoverishment rules allow spouses of Medicaid LTSS recipients to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s monthly income. These rules apply when one spouse receives Medicaid LTSS coverage, and the other spouse doesn’t have Medicaid.
In Tennessee in 2020, these “community spouses” are allowed to keep:
States are required to limit the home equity applicants for Medicaid nursing home and HCBS benefits can have. In 2020, states set this home equity level based on a federal minimum of $595,000 and maximum of $893,000.
Tennessee uses the federal minimum home equity limit – meaning applicants with more than $595,000 in home equity are ineligible for LTSS programs.
Because long-term care is expensive, individuals can have an incentive to give away or transfer assets to qualify for Medicaid LTSS. To curb these asset transfers, federal law requires states to institute a penalty period for applicants seeking nursing home benefits who have given away or transferred assets for less than their value. Most states also have a penalty period for HCBS.
Tennessee chooses to have an asset transfer penalty for both nursing home care and HCBS. This penalty is based on a 60-month lookback period when asset transfers and gifts are not allowed. The penalty is calculated by dividing the value of asset transfers and gifts by the monthly cost of nursing home care (which is about $5,472 in 2020).
A state’s Medicaid agency is required to attempt to recover what it paid for LTSS and related medical expenses for enrollees covered starting at the age of 55. States can choose to also recover the cost of other Medicaid benefits, and to recover from estates of enrollees who didn’t receive LTSS.
Tennessee has chosen to only recover from Medicaid enrollees who received long-term care while 55 or older.
When Medicaid coverage was administered by an insurer (i.e., a Medicaid managed care plan), the state will attempt to recover what it paid the insurer. That means the estate recovery amount could be more (or less) than the actual cost of Medicaid services received. Most Tennessee Medicaid beneficiaries who don’t have Medicare are enrolled in Medicaid managed care plans, but this is not the case for enrollees who are 65 or older or have disabilities.
Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery starting with benefits paid after December 31, 2009, but Medicaid may attempt to recover the cost of MSP benefits paid through that date. This could only occur in Tennessee if an an enrollee received LTSS.
Free volunteer Medicare counseling is available by contacting the Tennessee State Health Insurance Assistance Program (SHIP) at 1-877-801-0044. This program is offered through the Tennessee Commission on Aging and Disability.
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 contains Medicare counseling locations in each county.
Elder law attorneys can help individuals plan for Medicaid long-term care benefits. Use this search feature from the National Academy of Elder Law Attorneys (NAELA) to find an elder attorney in your area.
Tennessee’s Medicaid program is overseen Tennessee Division of TennCare. You can apply for Medicaid ABD or an MSP using this website or by calling TennCare Connect at 855-259-0701.
This website contains more information about submitting a Medicaid application.
An in-person interview is always required when applying for long-term care benefits, and some states also require one for Medicaid ABD. However, interviews are no longer required for MSP benefits.
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 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.