Medicare Ratings Guide

Author: Dr. Patricia Chen

  • Medicare Coverage for Diabetes in Arizona 2026: What’s Covered & Costs

    Medicare Coverage for Diabetes in Arizona

    Medicare Part A Coverage Yes — hospital and inpatient care
    Medicare Part B Coverage Yes — 80% after deductible
    Medicare Part D Coverage Yes — prescription drugs covered
    Your Cost Share (Part B) 20% after $240 deductible
    Average Annual Medicare Cost (Diabetes) $14,400
    Medicare Beneficiaries in Arizona 1,320,000

    Does Medicare Cover Diabetes in Arizona?

    Yes — Medicare covers diabetes treatment in Arizona under both Part A (hospital/inpatient) and Part B (outpatient/physician services). The average annual Medicare cost for Diabetes is approximately $14,400, with Medicare paying 80% of approved charges after the Part B deductible ($240 in 2026).

    What Medicare Covers for Diabetes in Arizona

    • insulin
    • blood glucose monitors
    • test strips
    • A1C tests
    • foot exams
    • eye exams
    • kidney disease screenings
    • diabetes self-management training

    Your Out-of-Pocket Costs for Diabetes in Arizona

    Under Original Medicare in Arizona, you pay 20% of all Part B-covered diabetes services after meeting the annual deductible ($240 in 2026). There is no out-of-pocket maximum under Original Medicare, which means costs can add up significantly for serious conditions. The average Arizona Medicare beneficiary with diabetes pays approximately $2,880/year in out-of-pocket costs under Original Medicare.

    Cost Comparison: Original Medicare vs. Medicare Advantage for Diabetes in Arizona

    Coverage Type Annual Out-of-Pocket (Estimated) Out-of-Pocket Maximum Prescription Coverage
    Original Medicare (Parts A+B) $2,880 No limit Separate Part D plan required
    Original Medicare + Medigap Plan G $960 + $1,536 Medigap premiums Effectively capped Separate Part D plan required
    Medicare Advantage (avg in Arizona) Varies by plan Capped (varies) Usually included

    Medicare Advantage Coverage for Diabetes in Arizona

    Medicare Advantage plans in Arizona must cover all services that Original Medicare covers for diabetes, but may have different cost-sharing structures. With 52 MA plans available in Arizona, you can compare plans specifically for their diabetes coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in Arizona is rated 4.1 stars by CMS.

    Medicare Part D Coverage for Diabetes Medications in Arizona

    Medicare Part D covers prescription drugs used to treat diabetes in Arizona. In 2026, the maximum out-of-pocket cap for Part D drugs is $2100/year — a significant protection for patients with high drug costs. Arizona has 26 standalone Part D plans available. Drug coverage varies by plan formulary, so compare plans at medicare.gov/plan-compare to find the best coverage for your specific medications.

    Medicaid and Diabetes in Arizona

    Arizona has fully expanded Medicaid under the Affordable Care Act, meaning adults earning up to 138% of the Federal Poverty Level ($22,025/year for an individual) qualify for Medicaid coverage. For dual-eligible individuals in Arizona with diabetes, Medicaid covers Medicare cost-sharing (premiums, deductibles, and copays), providing comprehensive coverage with minimal out-of-pocket costs.

  • Medicare Coverage for Diabetes in Alaska 2026: What’s Covered & Costs

    Medicare Coverage for Diabetes in Alaska

    Medicare Part A Coverage Yes — hospital and inpatient care
    Medicare Part B Coverage Yes — 80% after deductible
    Medicare Part D Coverage Yes — prescription drugs covered
    Your Cost Share (Part B) 20% after $240 deductible
    Average Annual Medicare Cost (Diabetes) $14,400
    Medicare Beneficiaries in Alaska 95,000

    Does Medicare Cover Diabetes in Alaska?

    Yes — Medicare covers diabetes treatment in Alaska under both Part A (hospital/inpatient) and Part B (outpatient/physician services). The average annual Medicare cost for Diabetes is approximately $14,400, with Medicare paying 80% of approved charges after the Part B deductible ($240 in 2026).

    What Medicare Covers for Diabetes in Alaska

    • insulin
    • blood glucose monitors
    • test strips
    • A1C tests
    • foot exams
    • eye exams
    • kidney disease screenings
    • diabetes self-management training

    Your Out-of-Pocket Costs for Diabetes in Alaska

    Under Original Medicare in Alaska, you pay 20% of all Part B-covered diabetes services after meeting the annual deductible ($240 in 2026). There is no out-of-pocket maximum under Original Medicare, which means costs can add up significantly for serious conditions. The average Alaska Medicare beneficiary with diabetes pays approximately $2,880/year in out-of-pocket costs under Original Medicare.

    Cost Comparison: Original Medicare vs. Medicare Advantage for Diabetes in Alaska

    Coverage Type Annual Out-of-Pocket (Estimated) Out-of-Pocket Maximum Prescription Coverage
    Original Medicare (Parts A+B) $2,880 No limit Separate Part D plan required
    Original Medicare + Medigap Plan G $960 + $2,376 Medigap premiums Effectively capped Separate Part D plan required
    Medicare Advantage (avg in Alaska) Varies by plan Capped (varies) Usually included

    Medicare Advantage Coverage for Diabetes in Alaska

    Medicare Advantage plans in Alaska must cover all services that Original Medicare covers for diabetes, but may have different cost-sharing structures. With 4 MA plans available in Alaska, you can compare plans specifically for their diabetes coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in Alaska is rated 3.5 stars by CMS.

    Medicare Part D Coverage for Diabetes Medications in Alaska

    Medicare Part D covers prescription drugs used to treat diabetes in Alaska. In 2026, the maximum out-of-pocket cap for Part D drugs is $2100/year — a significant protection for patients with high drug costs. Alaska has 18 standalone Part D plans available. Drug coverage varies by plan formulary, so compare plans at medicare.gov/plan-compare to find the best coverage for your specific medications.

    Medicaid and Diabetes in Alaska

    Alaska has fully expanded Medicaid under the Affordable Care Act, meaning adults earning up to 138% of the Federal Poverty Level ($22,025/year for an individual) qualify for Medicaid coverage. For dual-eligible individuals in Alaska with diabetes, Medicaid covers Medicare cost-sharing (premiums, deductibles, and copays), providing comprehensive coverage with minimal out-of-pocket costs.

  • Medicare Coverage for Diabetes in Alabama 2026: What’s Covered & Costs

    Medicare Coverage for Diabetes in Alabama

    Medicare Part A Coverage Yes — hospital and inpatient care
    Medicare Part B Coverage Yes — 80% after deductible
    Medicare Part D Coverage Yes — prescription drugs covered
    Your Cost Share (Part B) 20% after $240 deductible
    Average Annual Medicare Cost (Diabetes) $14,400
    Medicare Beneficiaries in Alabama 1,050,000

    Does Medicare Cover Diabetes in Alabama?

    Yes — Medicare covers diabetes treatment in Alabama under both Part A (hospital/inpatient) and Part B (outpatient/physician services). The average annual Medicare cost for Diabetes is approximately $14,400, with Medicare paying 80% of approved charges after the Part B deductible ($240 in 2026).

    What Medicare Covers for Diabetes in Alabama

    • insulin
    • blood glucose monitors
    • test strips
    • A1C tests
    • foot exams
    • eye exams
    • kidney disease screenings
    • diabetes self-management training

    Your Out-of-Pocket Costs for Diabetes in Alabama

    Under Original Medicare in Alabama, you pay 20% of all Part B-covered diabetes services after meeting the annual deductible ($240 in 2026). There is no out-of-pocket maximum under Original Medicare, which means costs can add up significantly for serious conditions. The average Alabama Medicare beneficiary with diabetes pays approximately $2,880/year in out-of-pocket costs under Original Medicare.

    Cost Comparison: Original Medicare vs. Medicare Advantage for Diabetes in Alabama

    Coverage Type Annual Out-of-Pocket (Estimated) Out-of-Pocket Maximum Prescription Coverage
    Original Medicare (Parts A+B) $2,880 No limit Separate Part D plan required
    Original Medicare + Medigap Plan G $960 + $1,704 Medigap premiums Effectively capped Separate Part D plan required
    Medicare Advantage (avg in Alabama) Varies by plan Capped (varies) Usually included

    Medicare Advantage Coverage for Diabetes in Alabama

    Medicare Advantage plans in Alabama must cover all services that Original Medicare covers for diabetes, but may have different cost-sharing structures. With 28 MA plans available in Alabama, you can compare plans specifically for their diabetes coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in Alabama is rated 3.8 stars by CMS.

    Medicare Part D Coverage for Diabetes Medications in Alabama

    Medicare Part D covers prescription drugs used to treat diabetes in Alabama. In 2026, the maximum out-of-pocket cap for Part D drugs is $2100/year — a significant protection for patients with high drug costs. Alabama has 22 standalone Part D plans available. Drug coverage varies by plan formulary, so compare plans at medicare.gov/plan-compare to find the best coverage for your specific medications.

    Medicaid and Diabetes in Alabama

    Alabama has not expanded Medicaid, meaning most adults without dependent children do not qualify for Medicaid regardless of income. Only parents earning up to 18% FPL ($4,918/year for a family of three) may qualify. For dual-eligible individuals in Alabama with diabetes, Medicaid covers Medicare cost-sharing (premiums, deductibles, and copays), providing comprehensive coverage with minimal out-of-pocket costs.

  • Medicaid Eligibility in District of Columbia 2026: Income Limits, Requirements & How to Apply

    Medicaid in District of Columbia: 2026 Income Limits

    Medicaid Program Single Person Married Couple
    Nursing Home / Institutional Medicaid $2,982/month $5,964/month
    HCBS Waiver (home-based care) $2,982/month $5,964/month
    Regular Medicaid (Aged, Blind, Disabled) $1,118/month $1,677/month
    ACA Expansion (working-age adults) 138% FPL = $1,831/month 138% FPL = $2,480/month

    Medicaid Expansion Status in District of Columbia

    District of Columbia has fully expanded Medicaid under the Affordable Care Act, meaning adults earning up to 138% of the Federal Poverty Level ($22,025/year for an individual) qualify for Medicaid coverage.

    Who Qualifies for Medicaid in District of Columbia?

    Medicaid in District of Columbia covers several distinct groups, each with different income and eligibility requirements. The major categories are: seniors (65+), people with disabilities, pregnant women, children, and low-income adults (if the state has expanded Medicaid).

    Medicaid for Seniors (65+) in District of Columbia

    Seniors in District of Columbia may qualify for Medicaid to cover nursing home care, home-based care, or to supplement Medicare coverage. The income limit for Regular Medicaid (Aged, Blind, and Disabled) in District of Columbia is $1,118/month for a single person. For nursing home care, the limit is $2,982/month.

    Medicaid for People with Disabilities in District of Columbia

    People with disabilities who receive SSDI or SSI may qualify for Medicaid in District of Columbia. SSI recipients automatically qualify for Medicaid in most states. SSDI recipients must wait 24 months for Medicare, during which Medicaid may provide coverage if income is below $1,118/month.

    How to Apply for Medicaid in District of Columbia

    You can apply for Medicaid in District of Columbia through the following channels:

    • Online: Through District of Columbia’s state Medicaid portal or HealthCare.gov
    • Phone: Call District of Columbia’s Medicaid office directly
    • In person: Visit your local Department of Social Services or Medicaid office
    • Mail: Download and mail a paper application

    Medicaid and Medicare Dual Eligibility in District of Columbia

    Individuals who qualify for both Medicare and Medicaid are called “dual eligibles.” In District of Columbia, dual eligible individuals receive comprehensive coverage: Medicare covers most medical services, while Medicaid covers Medicare premiums, deductibles, copays, and additional services like long-term care. There are approximately 17,640 dual-eligible individuals in District of Columbia.

    Medicaid Asset Limits in District of Columbia

    In addition to income limits, Medicaid for long-term care in District of Columbia has asset limits. For a single applicant, the countable asset limit is typically $2,000. For a married couple where one spouse needs nursing home care, the community spouse may keep up to $157,920 in countable assets (the Community Spouse Resource Allowance, or CSRA, for 2026). The primary home, one vehicle, personal belongings, and certain other assets are typically exempt.

  • Medicaid Eligibility in Wyoming 2026: Income Limits, Requirements & How to Apply

    Medicaid in Wyoming: 2026 Income Limits

    Medicaid Program Single Person Married Couple
    Nursing Home / Institutional Medicaid $2,982/month $5,964/month
    HCBS Waiver (home-based care) $2,982/month $5,964/month
    Regular Medicaid (Aged, Blind, Disabled) $994/month $1,491/month
    ACA Expansion (working-age adults) Not available (state not expanded) Not available

    Medicaid Expansion Status in Wyoming

    Wyoming has not expanded Medicaid, meaning most adults without dependent children do not qualify for Medicaid regardless of income. Only parents earning up to 43% FPL ($11,748/year for a family of three) may qualify.

    Who Qualifies for Medicaid in Wyoming?

    Medicaid in Wyoming covers several distinct groups, each with different income and eligibility requirements. The major categories are: seniors (65+), people with disabilities, pregnant women, children, and low-income adults (limited eligibility in non-expansion states).

    Medicaid for Seniors (65+) in Wyoming

    Seniors in Wyoming may qualify for Medicaid to cover nursing home care, home-based care, or to supplement Medicare coverage. The income limit for Regular Medicaid (Aged, Blind, and Disabled) in Wyoming is $994/month for a single person. For nursing home care, the limit is $2,982/month.

    Medicaid for People with Disabilities in Wyoming

    People with disabilities who receive SSDI or SSI may qualify for Medicaid in Wyoming. SSI recipients automatically qualify for Medicaid in most states. SSDI recipients must wait 24 months for Medicare, during which Medicaid may provide coverage if income is below $994/month.

    How to Apply for Medicaid in Wyoming

    You can apply for Medicaid in Wyoming through the following channels:

    • Online: Through Wyoming’s state Medicaid portal or HealthCare.gov
    • Phone: Call Wyoming’s Medicaid office directly
    • In person: Visit your local Department of Social Services or Medicaid office
    • Mail: Download and mail a paper application

    Medicaid and Medicare Dual Eligibility in Wyoming

    Individuals who qualify for both Medicare and Medicaid are called “dual eligibles.” In Wyoming, dual eligible individuals receive comprehensive coverage: Medicare covers most medical services, while Medicaid covers Medicare premiums, deductibles, copays, and additional services like long-term care. There are approximately 21,600 dual-eligible individuals in Wyoming.

    Medicaid Asset Limits in Wyoming

    In addition to income limits, Medicaid for long-term care in Wyoming has asset limits. For a single applicant, the countable asset limit is typically $2,000. For a married couple where one spouse needs nursing home care, the community spouse may keep up to $157,920 in countable assets (the Community Spouse Resource Allowance, or CSRA, for 2026). The primary home, one vehicle, personal belongings, and certain other assets are typically exempt.

  • Medicaid Eligibility in Wisconsin 2026: Income Limits, Requirements & How to Apply

    Medicaid in Wisconsin: 2026 Income Limits

    Medicaid Program Single Person Married Couple
    Nursing Home / Institutional Medicaid $2,982/month $5,964/month
    HCBS Waiver (home-based care) $2,982/month $5,964/month
    Regular Medicaid (Aged, Blind, Disabled) $994/month $1,491/month
    ACA Expansion (working-age adults) Not available (state not expanded) Not available

    Medicaid Expansion Status in Wisconsin

    Wisconsin has partially expanded Medicaid. Adults earning up to 100% FPL may qualify, but the state has not adopted full ACA expansion to 138% FPL.

    Who Qualifies for Medicaid in Wisconsin?

    Medicaid in Wisconsin covers several distinct groups, each with different income and eligibility requirements. The major categories are: seniors (65+), people with disabilities, pregnant women, children, and low-income adults (limited eligibility in non-expansion states).

    Medicaid for Seniors (65+) in Wisconsin

    Seniors in Wisconsin may qualify for Medicaid to cover nursing home care, home-based care, or to supplement Medicare coverage. The income limit for Regular Medicaid (Aged, Blind, and Disabled) in Wisconsin is $994/month for a single person. For nursing home care, the limit is $2,982/month.

    Medicaid for People with Disabilities in Wisconsin

    People with disabilities who receive SSDI or SSI may qualify for Medicaid in Wisconsin. SSI recipients automatically qualify for Medicaid in most states. SSDI recipients must wait 24 months for Medicare, during which Medicaid may provide coverage if income is below $994/month.

    How to Apply for Medicaid in Wisconsin

    You can apply for Medicaid in Wisconsin through the following channels:

    • Online: Through Wisconsin’s state Medicaid portal or HealthCare.gov
    • Phone: Call Wisconsin’s Medicaid office directly
    • In person: Visit your local Department of Social Services or Medicaid office
    • Mail: Download and mail a paper application

    Medicaid and Medicare Dual Eligibility in Wisconsin

    Individuals who qualify for both Medicare and Medicaid are called “dual eligibles.” In Wisconsin, dual eligible individuals receive comprehensive coverage: Medicare covers most medical services, while Medicaid covers Medicare premiums, deductibles, copays, and additional services like long-term care. There are approximately 230,400 dual-eligible individuals in Wisconsin.

    Medicaid Asset Limits in Wisconsin

    In addition to income limits, Medicaid for long-term care in Wisconsin has asset limits. For a single applicant, the countable asset limit is typically $2,000. For a married couple where one spouse needs nursing home care, the community spouse may keep up to $157,920 in countable assets (the Community Spouse Resource Allowance, or CSRA, for 2026). The primary home, one vehicle, personal belongings, and certain other assets are typically exempt.

  • Medicaid Eligibility in West Virginia 2026: Income Limits, Requirements & How to Apply

    Medicaid in West Virginia: 2026 Income Limits

    Medicaid Program Single Person Married Couple
    Nursing Home / Institutional Medicaid $2,982/month $5,964/month
    HCBS Waiver (home-based care) $2,982/month $5,964/month
    Regular Medicaid (Aged, Blind, Disabled) $994/month $1,491/month
    ACA Expansion (working-age adults) 138% FPL = $1,831/month 138% FPL = $2,480/month

    Medicaid Expansion Status in West Virginia

    West Virginia has fully expanded Medicaid under the Affordable Care Act, meaning adults earning up to 138% of the Federal Poverty Level ($22,025/year for an individual) qualify for Medicaid coverage.

    Who Qualifies for Medicaid in West Virginia?

    Medicaid in West Virginia covers several distinct groups, each with different income and eligibility requirements. The major categories are: seniors (65+), people with disabilities, pregnant women, children, and low-income adults (if the state has expanded Medicaid).

    Medicaid for Seniors (65+) in West Virginia

    Seniors in West Virginia may qualify for Medicaid to cover nursing home care, home-based care, or to supplement Medicare coverage. The income limit for Regular Medicaid (Aged, Blind, and Disabled) in West Virginia is $994/month for a single person. For nursing home care, the limit is $2,982/month.

    Medicaid for People with Disabilities in West Virginia

    People with disabilities who receive SSDI or SSI may qualify for Medicaid in West Virginia. SSI recipients automatically qualify for Medicaid in most states. SSDI recipients must wait 24 months for Medicare, during which Medicaid may provide coverage if income is below $994/month.

    How to Apply for Medicaid in West Virginia

    You can apply for Medicaid in West Virginia through the following channels:

    • Online: Through West Virginia’s state Medicaid portal or HealthCare.gov
    • Phone: Call West Virginia’s Medicaid office directly
    • In person: Visit your local Department of Social Services or Medicaid office
    • Mail: Download and mail a paper application

    Medicaid and Medicare Dual Eligibility in West Virginia

    Individuals who qualify for both Medicare and Medicaid are called “dual eligibles.” In West Virginia, dual eligible individuals receive comprehensive coverage: Medicare covers most medical services, while Medicaid covers Medicare premiums, deductibles, copays, and additional services like long-term care. There are approximately 86,400 dual-eligible individuals in West Virginia.

    Medicaid Asset Limits in West Virginia

    In addition to income limits, Medicaid for long-term care in West Virginia has asset limits. For a single applicant, the countable asset limit is typically $2,000. For a married couple where one spouse needs nursing home care, the community spouse may keep up to $157,920 in countable assets (the Community Spouse Resource Allowance, or CSRA, for 2026). The primary home, one vehicle, personal belongings, and certain other assets are typically exempt.

  • Medicaid Eligibility in Washington 2026: Income Limits, Requirements & How to Apply

    Medicaid in Washington: 2026 Income Limits

    Medicaid Program Single Person Married Couple
    Nursing Home / Institutional Medicaid $2,982/month $5,964/month
    HCBS Waiver (home-based care) $2,982/month $5,964/month
    Regular Medicaid (Aged, Blind, Disabled) $1,118/month $1,677/month
    ACA Expansion (working-age adults) 138% FPL = $1,831/month 138% FPL = $2,480/month

    Medicaid Expansion Status in Washington

    Washington has fully expanded Medicaid under the Affordable Care Act, meaning adults earning up to 138% of the Federal Poverty Level ($22,025/year for an individual) qualify for Medicaid coverage.

    Who Qualifies for Medicaid in Washington?

    Medicaid in Washington covers several distinct groups, each with different income and eligibility requirements. The major categories are: seniors (65+), people with disabilities, pregnant women, children, and low-income adults (if the state has expanded Medicaid).

    Medicaid for Seniors (65+) in Washington

    Seniors in Washington may qualify for Medicaid to cover nursing home care, home-based care, or to supplement Medicare coverage. The income limit for Regular Medicaid (Aged, Blind, and Disabled) in Washington is $1,118/month for a single person. For nursing home care, the limit is $2,982/month.

    Medicaid for People with Disabilities in Washington

    People with disabilities who receive SSDI or SSI may qualify for Medicaid in Washington. SSI recipients automatically qualify for Medicaid in most states. SSDI recipients must wait 24 months for Medicare, during which Medicaid may provide coverage if income is below $1,118/month.

    How to Apply for Medicaid in Washington

    You can apply for Medicaid in Washington through the following channels:

    • Online: Through Washington’s state Medicaid portal or HealthCare.gov
    • Phone: Call Washington’s Medicaid office directly
    • In person: Visit your local Department of Social Services or Medicaid office
    • Mail: Download and mail a paper application

    Medicaid and Medicare Dual Eligibility in Washington

    Individuals who qualify for both Medicare and Medicaid are called “dual eligibles.” In Washington, dual eligible individuals receive comprehensive coverage: Medicare covers most medical services, while Medicaid covers Medicare premiums, deductibles, copays, and additional services like long-term care. There are approximately 266,400 dual-eligible individuals in Washington.

    Medicaid Asset Limits in Washington

    In addition to income limits, Medicaid for long-term care in Washington has asset limits. For a single applicant, the countable asset limit is typically $2,000. For a married couple where one spouse needs nursing home care, the community spouse may keep up to $157,920 in countable assets (the Community Spouse Resource Allowance, or CSRA, for 2026). The primary home, one vehicle, personal belongings, and certain other assets are typically exempt.

  • Medicaid Eligibility in Virginia 2026: Income Limits, Requirements & How to Apply

    Medicaid in Virginia: 2026 Income Limits

    Medicaid Program Single Person Married Couple
    Nursing Home / Institutional Medicaid $2,982/month $5,964/month
    HCBS Waiver (home-based care) $2,982/month $5,964/month
    Regular Medicaid (Aged, Blind, Disabled) $994/month $1,491/month
    ACA Expansion (working-age adults) 138% FPL = $1,831/month 138% FPL = $2,480/month

    Medicaid Expansion Status in Virginia

    Virginia has fully expanded Medicaid under the Affordable Care Act, meaning adults earning up to 138% of the Federal Poverty Level ($22,025/year for an individual) qualify for Medicaid coverage.

    Who Qualifies for Medicaid in Virginia?

    Medicaid in Virginia covers several distinct groups, each with different income and eligibility requirements. The major categories are: seniors (65+), people with disabilities, pregnant women, children, and low-income adults (if the state has expanded Medicaid).

    Medicaid for Seniors (65+) in Virginia

    Seniors in Virginia may qualify for Medicaid to cover nursing home care, home-based care, or to supplement Medicare coverage. The income limit for Regular Medicaid (Aged, Blind, and Disabled) in Virginia is $994/month for a single person. For nursing home care, the limit is $2,982/month.

    Medicaid for People with Disabilities in Virginia

    People with disabilities who receive SSDI or SSI may qualify for Medicaid in Virginia. SSI recipients automatically qualify for Medicaid in most states. SSDI recipients must wait 24 months for Medicare, during which Medicaid may provide coverage if income is below $994/month.

    How to Apply for Medicaid in Virginia

    You can apply for Medicaid in Virginia through the following channels:

    • Online: Through Virginia’s state Medicaid portal or HealthCare.gov
    • Phone: Call Virginia’s Medicaid office directly
    • In person: Visit your local Department of Social Services or Medicaid office
    • Mail: Download and mail a paper application

    Medicaid and Medicare Dual Eligibility in Virginia

    Individuals who qualify for both Medicare and Medicaid are called “dual eligibles.” In Virginia, dual eligible individuals receive comprehensive coverage: Medicare covers most medical services, while Medicaid covers Medicare premiums, deductibles, copays, and additional services like long-term care. There are approximately 302,400 dual-eligible individuals in Virginia.

    Medicaid Asset Limits in Virginia

    In addition to income limits, Medicaid for long-term care in Virginia has asset limits. For a single applicant, the countable asset limit is typically $2,000. For a married couple where one spouse needs nursing home care, the community spouse may keep up to $157,920 in countable assets (the Community Spouse Resource Allowance, or CSRA, for 2026). The primary home, one vehicle, personal belongings, and certain other assets are typically exempt.

  • Medicaid Eligibility in Vermont 2026: Income Limits, Requirements & How to Apply

    Medicaid in Vermont: 2026 Income Limits

    Medicaid Program Single Person Married Couple
    Nursing Home / Institutional Medicaid $2,982/month $5,964/month
    HCBS Waiver (home-based care) $2,982/month $5,964/month
    Regular Medicaid (Aged, Blind, Disabled) $1,118/month $1,677/month
    ACA Expansion (working-age adults) 138% FPL = $1,831/month 138% FPL = $2,480/month

    Medicaid Expansion Status in Vermont

    Vermont has fully expanded Medicaid under the Affordable Care Act, meaning adults earning up to 138% of the Federal Poverty Level ($22,025/year for an individual) qualify for Medicaid coverage.

    Who Qualifies for Medicaid in Vermont?

    Medicaid in Vermont covers several distinct groups, each with different income and eligibility requirements. The major categories are: seniors (65+), people with disabilities, pregnant women, children, and low-income adults (if the state has expanded Medicaid).

    Medicaid for Seniors (65+) in Vermont

    Seniors in Vermont may qualify for Medicaid to cover nursing home care, home-based care, or to supplement Medicare coverage. The income limit for Regular Medicaid (Aged, Blind, and Disabled) in Vermont is $1,118/month for a single person. For nursing home care, the limit is $2,982/month.

    Medicaid for People with Disabilities in Vermont

    People with disabilities who receive SSDI or SSI may qualify for Medicaid in Vermont. SSI recipients automatically qualify for Medicaid in most states. SSDI recipients must wait 24 months for Medicare, during which Medicaid may provide coverage if income is below $1,118/month.

    How to Apply for Medicaid in Vermont

    You can apply for Medicaid in Vermont through the following channels:

    • Online: Through Vermont’s state Medicaid portal or HealthCare.gov
    • Phone: Call Vermont’s Medicaid office directly
    • In person: Visit your local Department of Social Services or Medicaid office
    • Mail: Download and mail a paper application

    Medicaid and Medicare Dual Eligibility in Vermont

    Individuals who qualify for both Medicare and Medicaid are called “dual eligibles.” In Vermont, dual eligible individuals receive comprehensive coverage: Medicare covers most medical services, while Medicaid covers Medicare premiums, deductibles, copays, and additional services like long-term care. There are approximately 28,800 dual-eligible individuals in Vermont.

    Medicaid Asset Limits in Vermont

    In addition to income limits, Medicaid for long-term care in Vermont has asset limits. For a single applicant, the countable asset limit is typically $2,000. For a married couple where one spouse needs nursing home care, the community spouse may keep up to $157,920 in countable assets (the Community Spouse Resource Allowance, or CSRA, for 2026). The primary home, one vehicle, personal belongings, and certain other assets are typically exempt.