Guide for 2022 Medicaid Eligibility for Seniors and People with Disabilities in Vermont

People age 65 or older, or those with certain disabilities at any age, are typically eligible for Medicare. Medicare is government run health insurance program, but isn't free health insurance (unlike Medicaid, which is usually free health care coverage). However, Medicare recipients can be "dually eligible"—eligible for both Medicare and Medicaid—in which case Medicaid will help cover Medicare premiums and some other out-of-pocket medical expenses.

There are two groups of pathways to Medicaid eligibility: Modified Adjusted Gross Income (MAGI) pathways and non-MAGI pathways. The MAGI pathways are for people under 65 years old. The non-MAGI pathways are typically for people 65 and older or with a disability.

On this page, we'll cover the main Medicaid eligibility pathways and Medicare Savings Programs for adults aged 65 and older and for people with disabilities (of all ages): the non-MAGI pathways for Medicaid eligibility.

The eligibility criteria for these specific Medicaid pathways can be complicated, both in terms of how your income is counted and what your income needs to be under in order to be eligible. Depending on the complexity of your situation, you may want to receive assistance from a free Medicaid navigator.

How Income Is Counted

The non-MAGI pathways for Medicaid eligibility require meeting an income limit that is based on your household size. Unlike Medicaid eligibilty for people under 65, there typically is an asset test. When comparing your income to the income limits posted online, it is very important that you are calculating your income correctly. For some households, the real limits can be twice as high as the posted limit as up to half of your income can be ignored.

While some other benefit programs and MAGI Medicaid pathways use an income number that is close to your total household income, the programs on this page use a different formula for calculating your income. The income calculation includes a standard deduction of $20 and a $65 + 50% deduction for earned income, meaning that the effective income limit is significantly higher for households with earned income (meaning income from a job or self-employement).

Before referencing any charts below, you should convert your household's total income into your household's non-MAGI income. To do so apply these calculations in terms of your monthly income (including your spouse's income), or use our simple calculator below:

• Take the income earned from a job or self-employment
• Subtract $65 from that number
• Divide that number by 2
• Add all other income (not from a job)
• Subtract $20 from that number

The resulting number will be your non-MAGI income that you can compare to the income limits in the charts below. Be advised that this is a very general estimate. If there are children in the household, additional deductions to your income may apply.

Monthly Household Earned Income (from Job or Self-Employment)

Monthly Household Other Income

Calculate Non-MAGI Income

How Assets Are Counted

Assets (also referred to as resources) include things like cash in a bank account, stocks, bonds, and trusts. One home and one car are typically exempt, along with your personal belongings, however life insurance policies with cash values above $1,500 are often counted. Many states also count excess home equity, typically starting above $600,000.

Some households with significant assets choose to hire paid estate planning attorneys to help navigate the Medicaid application process and protect personal assets (particularly if applying for Medicaid for Long Term Care). For free assistance applying for Medicaid, you can look into getting assistance from a Navigator.

How Household Size is Counted

Your household size determines the income and asset limit for eligibility, as larger households are allowed a higher limit. Household size for Medicaid for people age 65 and is typicially one or two, depending on whether you are married.

In some cases, even if you're living with your spouse, the household size may be one for the income limit if your spouse has no or low income (below about $400 if no children in household) and is not also applying for Non-MAGI Medicaid.

The household size for the asset limit is a more straightforward, and more closely matches up with whether you're single or a couple. In some cases, a household could even be considered household size of one for income, and household size of two for assets. States vary in their rules for counting household size, so if it doesn't seem obvious for your situation, consider getting assistance from a navigator or nonprofit organization in your state.

Medicaid for Children with Disabilities

Children with disabilities are often eligible for additional programs. These programs vary state to state. For more information visit KidsWaivers.org.

Aged, Blind, Disabled (ABD) Medicaid Pathway

The Aged, Blind, and Disabled pathway to Medicaid eligibility is the most common pathway to eligibility for those with a disability or over 65 years old.

Income Limit

Asset Limit

Working People with Disabilities Medicaid Pathway

The Working People with Disabilities pathway to Medicaid eligibility is for people with disabilities that have at least $1 in earned income.

Income Limit

Asset Limit

Medically Needy Medicaid Pathway

The Medically Needy pathway to Medicaid eligibility allows people who spend a significant amount of their income on medical expenses to "spend down" their income to receive Medicaid. Your monthly medical expenses are subtracted from your non-MAGI income (the income used for the comparisons above) to get the final income that's used in the eligibility calculation. Meaning if your non-MAGI income is $1000, and you have $300 of monthly medical expenses, your income for the Medically Needy pathway would be $700.

The medically needy spend down pathway to Medicaid eligibility is available for children, people over 65, people with a disability, parents to children under 18, and pregnant women.

Income Limit

Asset Limit

Medicare Savings Programs

Medicare Savings Programs (MSPs) help low-income Medicare beneficiaries pay their Medicare premiums and in some case other Medicare-related expenses. If an individual is eligible for Medicare Part A, they may qualify for one of the MSPs below.

There are three common levels of MSPs. The Qualified Medicare Beneficiary program covers Part A & B premiums, as well as some other out-of-pocket expenses, while the Specified Low-Income and Qualifying Individuals programs cover Part B premiums only.

Qualified Medicare Beneficiary (QMB)

Specified Low-Income Medicare Beneficiaries (SLMB)

Qualifying Individuals (QI)

Medicaid for Long Term Care

Medicaid for Long Term Care provides support to those with long-lasting health problems or disabilities and includes services such as home health aides, nursing home care, and community based care that are not covered by regular Medicaid.

Most people would benefit from speaking to an expert before applying for Medicaid for long term care. If applying, consider contacting a Medicaid Navigator or a legal aid nonprofit in your state.

This website does not currently have any information about Medicaid for Long Term Care.

Apply

To apply, visit Medicare.gov for Medicaid Savings Plans or Medicaid.gov for Medicaid and navigate to the page for Vermont. For free assistance applying, contact a navigator.