Kara Sears
In the United States, Medicare and Medicaid are federal health insurance programs for the elderly, disabled, and people with low incomes. While Medicare is a federal program, Medicaid is jointly administered by the state and federal governments, and eligibility requirements vary by state. Common-law marriage, or a marriage that hasn't been solemnized by a ceremony, is recognized by Medicaid in certain states, including Colorado, Iowa, Kansas, Montana, New Hampshire, Oklahoma, Texas, Utah, and the District of Columbia. While Medicare does not explicitly recognize common-law marriage, it does allow a domestic partner covered under their spouse's health insurance plan to delay enrollment in Medicare Part B.
| Characteristics | Values |
|---|---|
| Common-law marriage recognition for Medicare | AARP and Forbes Magazine state that Medicare eligibility works differently for domestic partners (common-law spouses) than for formally married spouses. |
| Common-law marriage recognition for Medicaid | Common-law marriage is recognized in Colorado, Iowa, Kansas, Montana, New Hampshire, Oklahoma, Texas, Utah, and the District of Columbia. |
| Medicaid eligibility for unmarried couples | Medicaid treats unmarried couples as individuals with separate households, even if they share a residence. Eligibility is based on financial need and Modified Adjusted Gross Income (MAGI), which considers household size and income. |
| Medicaid eligibility for married couples | Married couples are treated as a single household for MAGI calculations. Only the income of the applicant spouse is considered for Nursing Home Medicaid, and their assets are considered jointly owned. |
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What You'll Learn
Medicaid eligibility for unmarried couples
Medicaid generally treats unmarried couples as individuals with separate households, even if they share a residence. This means that each person's income and assets are considered separately when determining eligibility. However, if the unmarried couple has children together, they may be considered a single household for Medicaid purposes, depending on the state and specific circumstances.
Income is a critical factor in determining Medicaid eligibility. Medicaid is designed to help individuals with limited income and resources, and those with high incomes may not qualify for benefits. The Modified Adjusted Gross Income (MAGI) methodology is commonly used to assess income for Medicaid eligibility. MAGI considers an individual's household size and income, and each state may have specific income limits for Medicaid eligibility.
Assets are another important consideration for unmarried couples seeking Medicaid eligibility. Countable assets typically include cash, stocks, and bonds, while exempt assets usually include the primary home, personal belongings, and one vehicle. The value of an individual's countable assets can impact their eligibility, as there are often asset limits for Medicaid.
In some cases, unmarried couples may consider getting married to qualify for Medicaid. Marriage can impact income and asset eligibility, as Medicaid often treats married couples as a single household. However, the decision to marry for Medicaid eligibility is complex and should consider the financial means of both individuals. Additionally, common-law marriage, recognized in some states, may impact Medicaid eligibility, but specific documentation may be required to prove the marriage.
Overall, determining Medicaid eligibility for unmarried couples requires careful consideration of income, assets, household size, and state-specific guidelines. Consulting with a Medicaid Planning expert or an elder law attorney can provide personalized guidance on navigating the complexities of Medicaid eligibility.
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Common-law marriage recognition for Medicare
In the United States, Medicare and Medicaid are two different programs that provide health insurance coverage to individuals. Medicare is a federal program that provides health insurance to individuals over the age of 65, as well as some younger people with disabilities. On the other hand, Medicaid is a state and federal program that provides health insurance to individuals with low incomes and assets.
When it comes to common-law marriage recognition, the situation is complex and varies depending on the state and the specific program. In general, common-law marriage is not recognized for Medicare eligibility in the same way that formal marriages are. However, some states do recognize common-law marriages for Medicaid eligibility.
For Medicare, spousal status can impact eligibility and benefits. However, the specific rules regarding common-law marriage and spousal recognition vary and are often complex. It is important for individuals in common-law marriages to seek guidance from official sources, such as the Social Security Administration, to understand their specific situation.
In contrast, Medicaid treats married couples as a single household for Modified Adjusted Gross Income (MAGI) calculations. This means that the income and assets of both spouses are considered when determining eligibility. In most cases, Medicaid eligibility is based on financial need, and individuals with high incomes or too many assets may not qualify. When only one spouse of a married couple applies for Nursing Home Medicaid, only the income of the applicant spouse is considered, while the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Additionally, certain assets, such as the couple's home, may be exempt from the asset limit if specific requirements are met.
It is worth noting that common-law marriage is only recognized in a limited number of states, including Colorado, Iowa, Kansas, Montana, New Hampshire, Oklahoma, Texas, Utah, and the District of Columbia. Therefore, when considering Medicaid eligibility, it is crucial to understand the specific laws and regulations of the state in question. Consulting with a Medicaid Planning expert or a licensed agent is highly recommended to navigate the complexities of Medicaid eligibility and common-law marriage recognition.
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Medicaid eligibility for married couples
In most states, each spouse is considered a single applicant when applying for Nursing Home Medicaid or an HCBS Medicaid Waiver. In this case, the "name on the check" rule is followed, meaning income is counted separately for each spouse. In 2025, each spouse can generally have up to $2,901 per month ($34,812 per year) in income. However, for Aged, Blind, and Disabled Medicaid, the income of both spouses is considered jointly, and an income limit for a household of two is used. In 2025, most states set the income limit at either 100% of the Federal Poverty Level for a household of two ($1,762.50 per month or $21,150 per year) or the SSI Federal Benefit Rate for couples ($1,450 per month or $17,400 per year).
When only one spouse of a married couple applies for Medicaid, the income and assets of the non-applicant spouse are not counted towards the applicant spouse's eligibility. This is known as the Community Spouse Resource Allowance (CSRA). The non-applicant spouse is allowed to retain a significant portion of the couple's assets without affecting the applicant spouse's eligibility. Additionally, the community spouse can keep the primary home, even if it exceeds the state's Medicaid asset limit.
In some states, there is a Medically Needy Pathway for Medicaid income eligibility, which allows applicants with high medical expenses to "spend down" their income to qualify for Medicaid. Medicaid planning for married couples can be challenging, especially when one spouse requires long-term care. It is important to seek professional advice to protect assets and meet Medicaid eligibility requirements effectively.
Regarding common-law marriage, it is recognized in Colorado, Iowa, Kansas, Montana, New Hampshire, Oklahoma, Texas, Utah, and the District of Columbia. However, it is best to consult a Medicaid Planning expert as the eligibility process is complex.
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Medicaid eligibility and household income
Medicaid is a joint federal and state program that provides health coverage to Americans with low incomes, including children, pregnant women, parents, seniors, and individuals with disabilities. Each state has its own requirements for Medicaid eligibility, and income limits vary depending on the marital status of the applicant, whether a spouse is also applying, and the type of Medicaid sought. For instance, Nursing Home Medicaid may have a different income limit than Medicaid Home and Community-Based Services.
The Affordable Care Act of 2010 established a new methodology for determining income eligibility for Medicaid, based on Modified Adjusted Gross Income (MAGI). MAGI is used to determine financial eligibility for most children, pregnant women, parents, and adults. It considers taxable income and tax-filing relationships. MAGI-based income counting rules do not apply to individuals whose eligibility is based on blindness, disability, or age (65 and older).
MAGI is adjusted gross income (AGI) plus tax-exempt interest, Social Security benefits not included in gross income, and excluded foreign income. Some forms of income that are non-taxable or only partially taxable are included in MAGI and affect financial eligibility for premium tax credits and Medicaid. For instance, tax-exempt interest on certain types of investments is included in MAGI, as are non-taxable Social Security benefits for people with no other source of income. Pre-tax deductions, such as health insurance premiums and retirement plan contributions, are not included in MAGI.
Medicaid eligibility is determined using yearly income, which prevents situations where applicants would be considered ineligible based on their monthly income. Some lump-sum income is treated differently by Medicaid than by the ACA marketplace, which considers it only in the month it is received.
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Medicaid eligibility and assets
Medicaid eligibility is largely determined by financial need. Applicants with high incomes or many assets may not qualify for benefits. When determining eligibility, Medicaid takes into account both income and assets.
Countable assets include liquid assets that can be turned into cash and used to pay for care. These include bank accounts, stocks, savings, life insurance policies, money market accounts, certificates of deposit, mutual funds, bonds, and property such as second homes and cars. However, not all assets are counted towards eligibility, and there are certain exempt assets. For instance, an individual's home is not counted towards the asset limit if they express an intent to return and their equity interest is below a state-specified value. Additionally, Medicaid does not penalize applicants for using assets to pay off existing debt, make home improvements, or purchase annuities, which can help convert liquid assets into exempt assets.
For married couples, the value of both spouses' assets is considered for eligibility. The income of both spouses is combined and considered jointly, regardless of whether the assets are held in joint or separate accounts. In most states, the income limit for couples in 2025 is $1,450 per month or $17,400 per year. However, when only one spouse is applying for Medicaid, the income and assets of the non-applicant spouse are usually not counted towards eligibility. This is known as the Community Spouse Resource Allowance (CSRA), which aims to prevent spousal impoverishment and ensure the community spouse has adequate finances. The minimum amount of the institutionalized spouse's income that the community spouse can keep is called the Minimum Monthly Maintenance Needs Allowance (MMMNA). Federal law sets minimum and maximum protected resource amounts, which were $18,552 and $92,760, respectively, in 2004.
For unmarried couples, Medicaid treats each partner as a separate household. Therefore, the income or assets of one partner will not impact the eligibility of the other. However, unmarried couples should be cautious about transferring assets to one another, as Medicaid has a "lookback period" of five years, during which asset transfers may result in penalties or delays in eligibility.
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Frequently asked questions
Medicare eligibility does not work the same for domestic partners (such as common-law spouses) as they do for formally married spouses. However, in some states, common-law marriage is recognized and certain evidence is required to prove common-law marriage to obtain spousal and survivor benefits.
Medicaid treats married couples as a single household for MAGI calculations. However, it is unclear whether this applies to common-law marriages. It is best to seek counsel from a Medicaid Planning expert.
Medicaid treats these couples as individuals with separate households, even if they share a residence.
Marriage can affect Medicaid eligibility, especially concerning income and assets. For example, if an unmarried applicant's monthly income is over the Medicaid limit, they are not income-eligible. However, if they marry someone with little to no income, part or all of their income could be transferred to the new spouse, making them income-eligible.
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