If you are on Medicaid and become eligible for Medicare then you may be in a Medicaid program that you are no longer eligible for. Most NJ FamilyCare enrollees between the ages of 19-64 are enrolled in Medicaid Expansion, also known as ABP Medicaid. You may see those letters on the front of your health insurance card. Once an enrollee gets Medicare, they are no longer eligible for this coverage and must be transferred to a different type of coverage, provided they are eligible for a different Medicaid plan.

The income limits for the Medicaid programs for people who have Medicare are different than the limits for those without Medicare. Check the notice you receive to make sure that your gross income is listed correctly. If you are living with someone who is providing housing support to you, that may also be counted as income.

When you are able to start Medicare, NJ FamilyCare will send you a letter telling you that you will need to switch coverage, if you are eligible. Your renewal form will ask for information that you did not need to provide previously. Before you started Medicare coverage, you did not need to provide information about your resources (for example, how much money you have in the bank or whether you have a life insurance policy) because assets did not matter. The new programs do consider that information, because they have asset limits.

NJ FamilyCare contains many different Medicaid programs. County caseworkers will be evaluating whether you might be eligible for other programs before you are terminated. Other programs include:

• New Jersey Care…Special, which is very similar to Medicaid coverage under the ABP program, including transportation and dental services, but the income limits are lower.
• NJ WorkAbility, if you had a disability determination from the Social Security Administration prior to age 65 and you have a full- or part-time job.
• Managed Long Term Supports and Services (MLTSS), if you need assistance with your activities of daily living, such as bathing, dressing and toileting. This program has much higher income limits but more requirements for eligibility.
• Medicare Savings Programs, which can help with payment of your Part B Premium. The notice should include information about those programs if you are being terminated because your income is too high. (People who qualify for these programs can also get help with their prescription drug costs.)

You should not turn down Medicare Part B because you don’t want to pay the premium and you think you don’t need it because you are  already covered by NJ FamilyCare Medicaid. You have six months after the date of your termination from NJ FamilyCare to sign up for Medicare, by contacting the Social Security Administration. The late enrollment penalty will not apply to you if you enroll during this grace period, but if you already turned down Part B, you might need to wait an additional year before your Part B coverage will start. In most cases, you can enroll in a Medicaid program that will help you pay the premium.

If you have been terminated and think you are still eligible, or you have any questions about having Medicare and Medicaid coverage, contact the LSNJ Health Care Access Project through the LSNJLAW Hotline at www.lsnjlawhotline.org (1-888-LSNJ-LAW, 1-888-576-5529), or your local Legal Services program.

This information last reviewed: Dec 26, 2024