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If you’re looking for senior living in Lombard, there’s a good chance you’ve seen how expensive eldercare can get. Even if you have a healthy income, you may be unsure that you’ll be able to cover all your medical expenses.

This is where Medicaid spend down comes in. Below, we’ll explain what Medicaid spend down is and answer some frequently asked questions about it. We hope this helps you determine your best options for financing your healthcare costs.

What Is Medicaid Spend Down?

If your income and assets disqualify you from Medicaid, you can still get help paying for your medical expenses. You just need to spend your “excess income,” i.e., the income that prevents you from being eligible for Medicaid.

Medicaid spend down can be compared to a deductible: once you put a certain portion of your income and assets towards the cost of medical care, you’re eligible to receive coverage for the rest of it.

To give an example, let’s say you’re making $100 more per month than the Medicaid income limit. Once you’ve spent that $100, you’ll be eligible to receive Medicaid benefits.

What Expenses Qualify for Medicaid Spend Down?

Typically, people meet the limits for their spend down using medical bills, including but not limited to:

  • Doctor’s visits
  • Hospital bills
  • Prescription costs
  • In-home care
  • Health insurance
  • Medical equipment (e.g., eyeglasses)

The rule of thumb is simple: if an expense would be covered by Medicaid, it will probably count towards your Medicaid spend down. This means that dental, podiatric, and chiropractic services all count toward your Medicaid spend down.

Along with these, there are some expenses that you may not immediately think of as being medical expenses. Transportation to healthcare services and modifications to your home designed to help you keep living in it safely are both considered essential. This means they are covered.

What Other Expenses Can Be Used to Help Me Reach My Medicaid Spend Down Goal?

Along with medical expenses, you can also include paying off debt when working towards your Medicaid spend down. While this can be medical debt, it also includes credit card debt, mortgages and car payments.

What If Someone Else Paid for a Medical Expense?

If someone else paid for your medical bill, you can still count it towards your Medicaid spend down. That said, you can only do so if they expect to be paid back for that expense. This is essentially a form of medical debt.

Forms of Proof for Medicaid Spend Down

There are two ways to show that you qualify for Medicaid spend down because of the expenses you’re paying for: bills and receipts. Receipts will show the expenses that you have paid for, while bills will show those that you haven’t.

Can I Use the Same Bill to Meet My Medicaid Spend Down Over Multiple Months?

If the entirety of a bill’s amount was counted toward your Medicaid spend down limit one month, you cannot use it another month. However, you can split the total cost of a bill over multiple months if this helps you meet your Medicaid spend down limit.

Is Medicaid Spend Down the Same in Every State?

No, Medicaid spend down rules vary based on the state you’re in, so it’s important to ensure you understand the rules and regulations in your area. In this article, we’re discussing Medicaid spend down in Illinois.

What Is the Maximum Income to Qualify for Medicaid in Illinois?

Medicaid income and asset limits vary based on marital status.  

Unmarried applicants can’t have more than $2,000 worth of assets. They also can’t make more than $1,073 per month. Married applicants applying together can’t make more than $1,452 per month, and they can’t have assets totaling more than $3,000.

Does Social Security Disqualify Me from Receiving Medicaid?

You can receive both Social Security and Medicaid, but the money you receive from Social Security will count as part of your income when determining Medicaid eligibility.

What Counts as a Countable Asset?

If assets could be used to pay for medical expenses, you need to liquidate them and use the money before qualifying for Medicaid.  

Your home and car don’t typically count toward this, since they are both essential living expenses, though there are some exceptions in the case of high-value homes (e.g., homes worth more than one million dollars). Furniture and common household items also don’t count.

While you are allowed to have assets outside of the exceptions, they cannot be valued at more than $2,000.

Can Any of My Past Assets Count Against Me?

When applying for Medicaid, the program will look back over the last five years of assets you held. This is known as the Five-Year Look-Back Period, and it is designed to prevent people from quickly giving away assets to qualify for the program.

This means that any assets that were given, or sold below market value, are counted against your spend down limit when you’re trying to get Medicaid.

Typical examples of this include gifts given to children, or even trusts you’ve set up for them. However, there are some financial arrangements that you may not even consider, such as paying a caregiver without having a formal care agreement.

How Long Will Medicaid Cover My Expenses Once I’ve Reached My Spend Down Goal?

Illinois counts Medicaid income limits on a month-by-month basis. This means that, once you’ve reached your spend down goal, you will be covered by Medicaid for the rest of the month.

For this reason, some people choose the months they get a medical card for. You need to continually meet the spend down goal every month in order to continue qualifying for Medicaid.

Because Medicaid income and asset limits are assessed on a monthly basis, you need to be mindful of any gifts you receive, and how they can impact your eligibility for Medicaid. If, for instance, you receive an inheritance, this will count as an asset that needs to be spent until you are eligible for Medicaid again.

Get Expert Senior Living Advisors in Lombard and the Surrounding Area

If you’re looking for senior living in Illinois or Wisconsin, you’ve come to the right place. At Senior Living Experts, we’re committed to helping seniors understand the options they have for living the best life possible.

We have home health providers, elder law attorneys, financial planners, SRES realtors, insurance experts, and more, all ready to assist you. Please don’t hesitate to reach out in order to speak with one of our experts.

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