How to Qualify for Both Medicare and Medicaid in North Carolina - Salines-Mondello Law Firm, PC | Wilmington Elder Law & Estate Planning Attorneys

Qualifying for both Medicare and Medicaid involves making careful decisions to ensure you meet the requirements for both programs while protecting your assets. Much like asset protection planning, which aims to shield your hard-earned assets from risks such as lawsuits, creditors, or bankruptcies, dual eligibility planning helps you navigate the complexities of both programs.

Understanding Dual Eligibility in North Carolina

Dual eligibility means you qualify for both Medicare and Medicaid. Medicare is a federal program primarily for individuals aged 65 and older, while Medicaid is a state and federal program assisting those with low income and limited resources. Being dual-eligible benefits you from both programs’ coverage, reducing out-of-pocket healthcare expenses.

Medicare Eligibility

To qualify for Medicare, you need to meet specific criteria:

Age 65 or Older: You automatically qualify for Medicare if you’re 65 or older. Enrollment typically starts three months before your 65th birthday and continues for seven months, including the month you turn 65 and the three months following your birthday.
Disability: If you’re under 65 but have a qualifying disability, you can qualify for Medicare. Specifically, you must have received Social Security Disability Insurance (SSDI) for at least 24 months. After the 24th month of receiving SSDI benefits, you will be automatically enrolled in Medicare.
End-Stage Renal Disease (ESRD): Individuals with ESRD, a permanent kidney failure requiring dialysis or a transplant, can qualify for Medicare at any age. To be eligible, you or your spouse must have enough work credits, be receiving or eligible for Social Security or Railroad Retirement benefits, or be the dependent child or spouse of someone who qualifies. Enrollment can start as early as the first month of dialysis treatment if certain conditions are met.

Additional criteria and conditions to consider include:

Amyotrophic Lateral Sclerosis (ALS): Also known as Lou Gehrig’s disease, individuals diagnosed with ALS qualify for Medicare as soon as they begin receiving SSDI benefits, without the usual 24-month waiting period.
Medicare Part A and Part B: Understanding the components of Medicare is also crucial. Medicare Part A covers hospital insurance, including inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Part B covers medical insurance, which includes doctor visits, outpatient care, medical supplies, and preventive services.
Medicare Part C and Part D: Medicare Advantage Plans (Part C) are an alternative to Original Medicare, offered by private companies approved by Medicare. They include Part A and Part B coverage and often Part D (prescription drug coverage). Medicare Part D provides standalone prescription drug coverage.
Special Enrollment Periods: If you missed enrolling in Medicare during your Initial Enrollment Period (IEP) and are eligible due to certain life events, such as losing employer coverage, you might qualify for a Special Enrollment Period (SEP) to sign up without penalty.

Medicaid Eligibility in North Carolina

Medicaid eligibility is a need-based program, and there are specific income and asset limits. For seniors, these limits can vary based on factors such as marital status, living situation, and the type of program you are applying for.

Programs for Dual-Eligible Individuals

North Carolina offers specific programs for those who qualify for both Medicare and Medicaid:

Qualified Medicare Beneficiary (QMB): This program helps cover Medicare Part A and Part B premiums, deductibles, co-pays, and coinsurance.
Specified Low-Income Medicare Beneficiary (SLMB): SLMB covers Medicare Part B premiums.
Qualifying Individual (QI): QI also covers Medicare Part B premiums but is subject to annual funding limits and is available on a first-come, first-served basis.
Qualified Disabled Working Individual (QDWI): This program helps pay for Medicare Part A premiums for certain disabled individuals who are working.

Application Process

To apply for both Medicare and Medicaid in North Carolina:

Medicare: If you’re turning 65, apply through the Social Security Administration (SSA). If you’re under 65 and disabled, you’ll be automatically enrolled after receiving SSDI for 24 months.
Medicaid: Apply through the North Carolina Department of Health and Human Services (DHHS). You can apply online, by mail, or in person at your local Department of Social Services (DSS) office.

The Look-Back Period

North Carolina has a five-year look-back period for Medicaid. Any asset transfers during this time are scrutinized and can result in penalties. Working with an experienced elder law attorney can help you navigate this period and avoid costly mistakes.

Contact Salines Mondello Law Firm

If you need assistance qualifying for Medicare and Medicaid in North Carolina, the experienced attorneys at Salines Mondello Law Firm are here to help. We have experience in elder law and can guide you through protecting your assets and ensuring eligibility for both programs.