Medicaid Spend-Down — Share of cost
A Medicaid spend-down lets people with too much income or assets qualify for Medicaid by using the excess on medical costs first.
Official source: medicaid.gov
A Medicaid "spend-down" helps people get Medicaid. Medicaid is a health care program for people with low income. To get Medicaid, your income and the things you own must be below certain amounts. If your income or what you own is slightly too high, a spend-down can help.Here is how a spend-down works. You use your extra income or money to pay for medical bills. These bills must be for care that Medicaid would usually cover. Once you have paid enough medical bills, your income or assets will be low enough for you to get Medicaid. Think of it like meeting a deductible for your health insurance. After you pay a certain amount, your insurance starts to cover costs.This matters because it makes health care affordable for more people. Without a spend-down, some people would not get Medicaid. They would have to pay full price for their medical care. This can be very costly. A spend-down can help people get the medical care they need. This can help many people, including seniors, people with disabilities, and families with high medical costs.If you think a Medicaid spend-down might help you, contact your state Medicaid office. They can tell you if you qualify. They can also explain exactly how a spend-down works in your state. See also: <a href="/glossary/medicaid-waiver">Medicaid Waiver</a>.
In real life
- A retiree with $1,000 over the limit qualifies after $1,000 in monthly medical bills.
- Sarah needed long-term care but had a little too much money saved. She paid for several months of her care herself until her savings dropped enough for Medicaid to kick in.
- David's income was slightly above the limit for Medicaid. He spent his extra money on his prescriptions and doctor visits, allowing him to then qualify for Medicaid.
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Frequently asked questions about Medicaid Spend-Down
What is Medicaid Spend-Down?+
A Medicaid spend-down lets people with too much income or assets qualify for Medicaid by using the excess on medical costs first.
Who qualifies for Medicaid Spend-Down?+
Income-eligible adults, children, pregnant people, seniors, and people with disabilities. Income limits and rules vary by state.
How do I apply for Medicaid Spend-Down?+
Apply through your state Medicaid agency (find yours at medicaid.gov) or through healthcare.gov. Official forms and instructions: https://www.medicaid.gov/medicaid/eligibility/index.html.
Where can I get help?+
Apply through your state Medicaid agency (links at medicaid.gov) or use BenefitKarma's Find Benefits tool to see if you qualify in your state.
Source: medicaid.gov