It may seem difficult to obtain Medicaid eligibility and eligibility for other government assistance programs, such as Social Security Disability Income. If you are receiving assistance from at least one federal program, however, you may qualify for more help than you realize.
If you already have Medicare eligibility, for example, you will not necessarily be denied assistance in another program. According to one study, approximately 9 million people are enrolled in both Medicare and Medicaid, which means they have dual eligibility.
You may determine your likelihood of qualifying for a government assistance program by using a pre-qualification quiz or visiting your local agency. There are also steps you may take to ensure that your application has the most accurate information available, so that you do not slow down the process.
If you need more government assistance than what you currently have, determining your eligibility for other programs is worthwhile. Learn more about eligibility for Medicaid, Medicare, the Children’s Health and Insurance Program (CHIP), the Supplemental Nutrition Assistance Program (SNAP) and the Women’s, Infants and Children (WIC) program below.
Your Medicaid eligibility is based mainly on your income. Modified Adjusted Gross Income (MAGI) is the model used to determine your financial eligibility. This model takes your taxable income and tax filing relationships into account. It does not assess your assets or resources.
Who is eligible for Medicaid? While low-income families are usually the ones to apply for assistance, you may qualify under different circumstances. For instance, you may qualify based on a medical condition or you do not have extra income to pay for high medical expenses.
If you are blind, have a disability or are 65 years of age or older, your eligibility will not be determined by MAGI. Instead, Medicaid may use the Supplemental Security Income (SSI) methodology. Some states may have stricter criteria to determine your eligibility for Medicaid.
Depending on your circumstances, you may qualify for the program even if your income is not low enough. This may be true if you are considered “medically needy,” meaning you spend a significant amount of money on necessary medical expenses. To qualify, you may subtract your medical expenses from your income.
Your Medicaid coverage will not increase or decrease depending on your eligibility level. Instead, your coverage may change depending on the state in which you live. However, your state must offer certain mandatory benefits, including inpatient and outpatient hospital services, physician services, laboratory and X-ray services and more. You must be a resident of your state to qualify for Medicaid in your state.
In general, Medicare eligibility is determined by an applicant’s age. Other qualifying applicants include people with disabilities and people who have End Stage Renal Disease (ESRD).
ESRD is also known as kidney failure, which requires dialysis or a kidney transplant to survive.
The cost of your Medicare coverage will depend on how you qualify for care and whether you are employed or retired. For instance, you may qualify for free Medicare Part A, or hospital insurance, if you are 65 years of age or older and you have paid taxes to Medicare for a minimum of 10 years.
You may also qualify for free Medicare Part A coverage if:
- Your spouse has paid 10 years of Medicare taxes.
- You qualify for Social Security benefits or Railroad Retirement Board (RRB) benefits.
- You currently receive Social Security benefits or Railroad benefits.
- You are employed by the government and considered a Medicare Qualified Government Employee (MQGE).
To learn more about your eligibility and how to qualify for Medicare, use the Medicare eligibility and premium calculator. Note that the calculator may only provide you with an estimate and may not work for all circumstances.
Your children may qualify for CHIP insurance if your income is too high to qualify for Medicaid, but you are having a difficult time affording their healthcare costs. You may also qualify if you are pregnant.
Through the Children’s Health Insurance Program Reauthorization Act (CHIPRA), many states allow pregnant women to receive healthcare in certain situations.
If you are thinking of applying for CHIP, check your state’s guidelines on eligibility. Every state has its own CHIP program and may determine eligibility using its own criteria.
This government assistance program is similar to Medicaid, because it uses your family’s income to determine whether you qualify. Most states may cover your children if you are at or above 200 percent of the Federal Poverty Level (FPL).
You may qualify for additional government benefits under the SNAP program if you and your family have a low income. The SNAP program is designed to help you with the cost of groceries, so that you can afford to eat nutritious foods without getting a personal loan.
You must meet the SNAP gross income limit and the net income limit to qualify. Gross income refers to the total income of your household, before deductions for certain medical expenses and other qualifying subtractions. Net income refers to the total income of your household, minus those deductions.
Allowable deductions also include:
- A 20 percent deduction from your salary.
- A deduction of $160 if one to three people live in your house, and $170 if there are four residents.
- A dependent care deduction if you work, are being trained for work or are enrolled in school.
You may also have SNAP eligibility if everyone in your household receives benefits from Temporary Assistance for Needy Families (TANF), SSI or certain other general assistance programs. In this case, you would be considered categorically eligible since another assistance program already found you eligible.
The WIC program may help you if you are pregnant or have a child up to 5 years of age and fall below a certain income level. You may also qualify if a healthcare professional determines that you and your child are at nutritional risk.
In order to be eligible based on how much you earn, your gross income must fall below 186 percent of the FPL. As an example, a family of two may earn $31,284 per year or less in order to qualify.
Note that these approximations change each year, so it is important to check the U.S. poverty income guidelines before you apply.
For WIC eligibility, a health care professional may recognize you as having one out of two types of nutritional risk. This includes medically based risks and diet-based risks.
Medically based risk include anemia, being underweight, being over a certain age or having a history of pregnancy complications. Diet-based risks are typically caused by an inadequate or poor diet.
If you participate in other government assistance programs, you may still qualify for WIC.
To learn more about WIC eligibility, use the WIC prescreening tool on the United States Department of Agriculture (USDA) USDA website.