Kenneth Guzman-Andrade
Licensed Life and
Health Insurance Broker
Written 7/31/2024
Medicare and Medicaid In New Jersey
Medicare
and Medicaid In New Jersey
Intro | Should I Take Medicare Now?
|How To Signup For Medicare | Medicare Secondary Options |
I'm Turning 65 But My Spouse Is Not |
Medicare Disability | Medicaid
"I would highly recommend him for anyone needing insurance"
Key Points:
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Medicare provides health insurance for people over 65 and those under 65 with disability status
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Medicaid provides health insurance to people within certain income and asset limits
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Qualifying for both is hard, but if you can, you can get Dual-Eligible Plans with added benefits
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In New Jersey, most people are disenrolled from Medicaid (called NJ FamilyCare) when they become Medicare eligible. This is due to the low income and asset limits for qualification.
Understanding how Medicare and Medicaid work in New Jersey can be difficult. They sound similar and seem to have many overlapping benefits. The truth is these two programs are very different and mixing them up can lead you to not getting the healthcare you deserve. In this article, we’ll discuss the differences between these two programs and specifically how Medicaid eligibility changes once you become Medicare-eligible here in New Jersey.
Quick Note: This article will help you better understand the Medicare and Medicaid systems, but we DO NOT help people apply for Medicaid. It is a state program and must be done with the state or an agency specializing in Medicaid applications.
Medicare vs Medicaid
Medicare is a federal program that provides Hospital and Medical coverage to people over 65 and people under 65 with disability status. Original Medicare does not consider income for eligibility; it only focuses on age and disability status. Original Medicare boasts a nationwide network of doctors and hospitals but lacks benefits people often seek, such as dental and vision care. It also does not cover nursing homes, which is important for later.
Many people like Original Medicare but find it lacks the comprehensive coverage they desire. To help address these coverage gaps, they often enroll in secondary policies such as Medicare Supplements, Medicare Part D plans, and Medicare Advantage plans. The secondary plans available to you and their cost can vary greatly depending on your location. Understanding the differences between these plans is our specialty, and if you’d like help choosing the best one for your health needs, contact NJ Life and Health today.
Medicaid is a federal and state program designed to help people on the lower end of the income spectrum obtain health insurance. Medicaid programs are managed by the states but receive federal funding. The benefits you receive on Medicaid and the eligibility requirements vary from state-to-state. To qualify for Medicaid, you must generally have a low income and low resources such as cash, stocks, and investments. But again, this varies.
Medicaid programs tend to have smaller networks. Due to low payments from the program, many doctors have opted not to take Medicaid patients. However, you will most likely have zero out-of-pocket costs if you are on Medicaid. Most programs have $0 monthly premiums and no required payments at Medicaid providers. Medicaid also tends to have more comprehensive benefits compared to Original Medicare. It often includes Hospital, Medical, Prescription, Dental, Vision, transportation coverage, and more. Most importantly, it can cover nursing homes.
In New Jersey, Medicaid is referred to as NJ Family Care.
NJ Family Care Aged, Blind and Disabled Explained
Now that you know the differences between Medicare and Medicaid, let’s talk about how they interact in New Jersey. If you are on Medicaid (NJ FamilyCare) in New Jersey and become eligible for Medicare, you will most likely be moved to a program called NJ FamilyCare Aged, Blind, and Disabled. (“ABD” for short.)
NJ FamilyCare ABD is designed for people who are “Dual-Eligible,” meaning they qualify for both Medicaid and Medicare. Once you are eligible for Medicare in New Jersey, it is very hard to maintain your Medicaid status.
As of 2024, the maximum income for an individual enrolled in NJ FamilyCare ABD is $1255 a month and $1704 per month for a couple. The resource maximums are $4000 for an individual and $6000 for a couple. [ 1 ] Unfortunately, due to this we are finding that many of our clients who have been happily enrolled in Medicaid, no longer qualify for it.
If you are in NJ FamilyCare and become eligible for ABD, they will transfer your case to your county Social Services office. At that point, all applications and correspondence will no longer be through the state NJ FamilyCare agency.
How COVID Affected Medicaid Eligibility
During COVID, the federal government stopped Medicaid disenrollment across the country. [2] This meant if you were in Medicaid, you couldn’t get kicked off, even if you were no longer eligible due to a change in income or Medicare status. We found many of our clients who were turning 65 or going onto disability during this time were able to keep Medicaid even though they weren’t eligible due to their income and resources. Over the last year, the federal government has implemented Medicaid “Unwinding.” This is the process of slowly making people who were in Medicaid reapply. A large percentage of our clients have found they are no longer Medicaid-eligible and have had to transition to Medicare.
If you are disenrolled from Medicaid, you are given a Medicare Special Enrollment Period, where you can choose to enroll in a Medicare Part D plan or a Medicare Advantage plan. Medicare supplements often require underwriting if it is outside of your Initial Enrollment Period or Open Enrollment Period.
Medicaid Dual-Eligibility Plans
If you can keep Medicaid once you are Medicare-eligible, you are in luck! Being “Dual-Eligible” means you can enroll in some fantastic Medicare plans. These Dual-Eligible plans not only have the potential to have $0 out-of-pocket medical costs but may include benefits like helping pay for groceries and utilities. If you are Dual-Eligible, contact NJ Life and Health to look into your options.
Why Is It So Hard To Keep Medicaid In NJ?
We talk to a lot of people who are on the low end of the income spectrum who wonder why it is so hard to keep Medicaid in New Jersey. The primary reason for this is Medicaid can help pay for nursing homes. Nursing homes are incredibly expensive, and the state does everything to ensure you qualify for this benefit. The process of applying for Medicaid for a nursing home is time-consuming and incredibly complex.
If you’d like more information on the process, watch our podcast with Senior Planning Services here: https://www.youtube.com/watch?v=eQCLGBxvyP8&t=279s.
Senior Planning Services is a company that focuses on helping people apply for Medicaid in New Jersey. They go in-depth on what to expect.
Reach out to them at https://www.seniorplanning.com/
Summary
Keeping Medicaid once you become eligible for Medicare in New Jersey can be difficult. We find that more often than not, people have to transition to just Medicare.
We recommend talking to NJ Life and Health a few months before becoming Medicare-eligible to review your options. We can help you get a fantastic Dual-Eligible plan if you maintain Medicaid. If you lose Medicaid, we can find a great Medicare secondary plan for your needs.
To contact us, call our Toms River, NJ office at 848-226-6897 or visit our website at www.njlifeandhealth.com.