Medicaid Eligibility After 65: Income, Assets, and Long-Term Care

Medicaid Eligibility After 65: A Plain Guide to Income, Assets, and Long-Term Care

Key takeaways

• Medicaid is run jointly by the federal government and each state. The rules are different in every state.[1]
• Many states tie eligibility for older adults to federal SSI figures. For 2026, these are $994 a month in income and $2,000 in countable assets for one person.[2][3]
• Medicaid pays for things Medicare usually doesn't, like long-term nursing home care.[1]
• If a married person needs long-term care, special spousal rules protect some income and savings for the spouse at home.[2][4]
• Gifts or sales below value in the 5 years before applying for long-term care can delay coverage.[5]
• Your state Medicaid office makes the decision. A SHIP counselor can help for free.[1][6]

What Medicaid is, and how it differs from Medicare

Medicare is health insurance mostly for people 65 and older. Medicaid helps people with limited income and resources pay for care.[1]

Many older adults have both. They are called "dually eligible."[1] If you have Medicare and full Medicaid, your state pays your Part B premium.[1] Depending on your level of Medicaid, it may also pay your Medicare deductibles and copays.[1] You also get Extra Help with drug costs automatically.[1]

Medicaid also covers services Medicare usually doesn't, such as nursing home care and personal care services.[1]

The federal starting point: 2026 figures

States set their own limits. But many use federal SSI amounts as a baseline. These figures come from CMS's 2026 standards chart.[2]

Source: CMS 2026 SSI and Spousal Impoverishment Standards.[2] SSI resource limits confirmed on SSA's site.[3]

These figures change every January. SSA has already announced the 2027 SSI amounts: $1,029 for one person and $1,544 for a couple, starting January 2027.[7] Your state's limit may be higher, lower, or calculated differently. Always check with your state.

What counts as an "asset"

Under SSI rules, countable resources include cash, bank accounts, stocks, and property you could turn into cash.[3] Some things usually do not count:[3]

• The home you live in and the land it sits on
• One vehicle used for transportation
• Household goods and personal items, like wedding rings
• Burial plots, and burial funds up to $1,500 per person
• Life insurance with a combined face value of $1,500 or less

States that use different rules may count things differently. Ask your state.

Too much income? Ask about "spend down"

Some states let you qualify even if your income is over the limit. You "spend down" the extra by paying medical bills and costs like Medicare premiums.[1] Medicare.gov suggests calling your state Medicaid office and asking about help for people with limited resources.[1]

Long-term care: the rules that matter most

Nursing homes are one of the main reasons older adults look into Medicaid. Three rules come up often.

1. Protections for the spouse at home

When one spouse needs nursing home care (or certain home-based care), federal "spousal impoverishment" rules keep the other spouse from losing everything.[2][4] For 2026, the federal figures are:[2]

Alaska and Hawaii use higher income allowances.[2] Each state picks where it falls in these ranges.[4]

2. Home equity limit

If your home equity is above a set limit, you may not qualify for long-term care coverage. For 2026, states must use a limit between $752,000 and $1,130,000.[2] Exceptions exist in some situations. Ask your state.

3. The 5-year look-back

When you apply for long-term care, the state looks back 60 months (5 years) for gifts or sales below fair value.[5] For example, giving cash to children or signing your house over to them.[5] If it finds one, there is a penalty: a period when Medicaid won't pay for long-term care.[5]

This is an area where a licensed elder law attorney can help. Don't move money around before getting advice.

After death: estate recovery

States must try to recover some Medicaid costs from the estates of people who were 55 or older when they got benefits, including nursing home costs.[8] Rules and exceptions vary by state.

Your checklist before you apply

Gather these first. It makes the application faster.

• Proof of age and identity
• Proof you live in the state
• Medicare card, and any other insurance cards
• Recent statements for all income (Social Security, pensions, other)
• 5 years of bank and investment statements (if applying for long-term care)
• Deeds, car titles, life insurance policies
• Records of any large gifts or property transfers
• Spouse's income and asset records, if married

This is a general list. Your state will tell you exactly what it needs.

See if you might qualify, then confirm with your state Medicaid office:

.

Where to get free help

• Your state Medicaid office. This is where you apply. Medicare.gov says to contact your State Medical Assistance (Medicaid) office.[1]

• Your SHIP. State Health Insurance Assistance Programs give free, unbiased help with Medicare and related questions. Find your state's SHIP at shiphelp.org.[6]

• Related: Long-term care insurance and costs

• Related: Medicare Advantage vs. Medigap

FAQ

What is the income limit for Medicaid for seniors? It depends on your state. Many states use the SSI amount as a baseline: $994 a month for one person in 2026.[2] Some states go higher, and some offer "spend down."[1]

Can I keep my house and still get Medicaid? Often, yes. Your home usually isn't counted as an asset under SSI rules.[3] For long-term care, there is a home equity limit of $752,000 to $1,130,000 in 2026, depending on the state.[2]

Can I have Medicare and Medicaid at the same time? Yes. People with both are called "dually eligible." Medicare pays first and Medicaid pays last.[1]

Does Medicaid pay for nursing homes? Medicaid offers benefits Medicare usually doesn't, including nursing home care.[1] You must meet your state's rules.

How far back does Medicaid look at my finances? For long-term care, 60 months (5 years) before you apply.[5]

Sources

1. Medicare.gov. Medicaid. Centers for Medicare & Medicaid Services. n.d. https://www.medicare.gov/basics/costs/help/medicaid. Accessed October 29, 2026.
2. Centers for Medicare & Medicaid Services, Center for Medicaid and CHIP Services. CMCS Informational Bulletin: Updated 2026 SSI and Spousal Impoverishment Standards (with 2026 standards chart). April 27, 2026. https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf. Accessed October 29, 2026.
3. Social Security Administration. SSI Resources. SSA. n.d. https://www.ssa.gov/ssi/text-resources-ussi.htm. Accessed October 29, 2026.
4. Medicaid.gov. Spousal Impoverishment. Centers for Medicare & Medicaid Services. n.d. https://www.medicaid.gov/medicaid/eligibility-policy/spousal-impoverishment. Accessed October 29, 2026.
5. Centers for Medicare & Medicaid Services. Transfer of Assets in the Medicaid Program (Deficit Reduction Act backgrounder). CMS. n.d. https://www.cms.gov/regulations-and-guidance/legislation/deficitreductionact/downloads/toabackgrounder.pdf. Accessed October 29, 2026.
6. SHIP National Technical Assistance Center. Find Your Local SHIP. n.d. https://www.shiphelp.org/about-medicare/regional-ship-location. Accessed October 29, 2026.
7. Social Security Administration, Office of the Chief Actuary. SSI Federal Payment Amounts for 2027. SSA. 2026. https://www.ssa.gov/oact/cola/SSI.html. Accessed October 29, 2026.
8. Medicaid.gov. Estate Recovery. Centers for Medicare & Medicaid Services. n.d. https://www.medicaid.gov/medicaid/eligibility-policy/estate-recovery. Accessed October 29, 2026.

Disclaimer

This article is for general education only and is not medical, legal, or financial advice. Talk to your doctor, a licensed attorney, or a SHIP counselor (Medicare) about your situation. In an emergency, call 911.

Medicaid rules and dollar limits vary by state and change every year. Your state Medicaid office makes the final decision. For free, unbiased help, contact your State Health Insurance Assistance Program (SHIP); find yours at shiphelp.org. For questions about transferring assets or estate planning, talk with a licensed elder law attorney in your state.

Attribution

Portions of this page are adapted from "HowToLiveBetter" (高性价比人生指南) by eternity4719, https://github.com/eternity4719/HowToLiveBetter, licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Changes: topic idea (public assistance when money is short) adapted from Chapter 07; fully rewritten for the U.S. Medicaid system and re-sourced to U.S. official guidance. No China-specific content retained. Not a direct translation.