Healthcare expenses can be challenging, but Illinois Medicaid offers financial relief to eligible individuals. If your income is above the Medicaid threshold, you may still qualify through a process called "spenddown." This guide explains how the spenddown program works and how you can benefit from it.
What is a Spenddown?
A "spenddown" functions like a deductible for your Illinois Medicaid benefits. If your income exceeds the Medicaid eligibility limit, you can still qualify by incurring medical expenses up to a certain amount before Medicaid starts covering costs.
How it Works?
Determine Your Spenddown Amount: The Illinois Department of Healthcare and Family Services (HFS) calculates how much your income exceeds the Medicaid limit. This excess amount is your "spenddown."
Accumulate Medical Expenses: You must incur eligible medical expenses equal to or greater than your spenddown amount within a set period.
Submit Proof to HFS: Provide medical bills from doctors, hospitals, pharmacies, or other healthcare providers as proof.
Medicaid Coverage Begins: Once your spenddown amount is met, Medicaid will cover eligible medical expenses for the rest of the spenddown period.
When Do You Pay Your Spenddown?
You do not pay your spenddown directly to HFS.
Instead, you accumulate eligible medical expenses that add up to your spenddown amount.
Your spenddown period could be a month or six months, depending on your case.
Once the spenddown is met, Medicaid covers the rest of your eligible medical expenses for that period.
You must meet your spenddown again in the next period to continue receiving Medicaid benefits.
Key Points to Remember
Eligible Expenses: Only certain medical expenses count toward your spenddown. Contact HFS to verify which expenses qualify.
Keep Records: Maintain accurate documentation of all your medical bills and payments.
Spenddown Periods: Your spenddown period is determined by HFS and varies based on individual circumstances.
How to Get More Information and Apply
For assistance with your Medicaid spenddown, contact the Illinois Department of Healthcare and Family Services (HFS):
Website: Visit the HFS website
Phone: Call the HFS hotline at 877-912-8880, 1-800-843-6154, or 1-866-324-5553 (TTY)
Local Office: Locate an HFS office near you by visiting the website or calling the hotline.
Application: Apply for Medicaid online, by phone, or in person at an HFS office.
Need Help?
If you have any questions, reach out to an HFS representative for guidance on meeting your spenddown and maximizing your Medicaid benefits.
Understanding and managing your spenddown ensures continued access to healthcare and financial assistance when you need it most.
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