Navigating the healthcare system can be challenging, especially for “Dual Eligible” individuals who are already on Medicare. Low income Medicare recipients in New Jersey may also qualify for Aged Blind Disabled (ABD) Medicaid which provides crucial support to help cover medical expenses and services that are not covered by Medicare. This blog will walk you through the basics of qualifying for ABD Medicaid in New Jersey, including eligibility criteria, and the application process.
What is Aged Blind Disabled Medicaid?
ABD Medicaid is a federally funded program designed to supplement the coverage provided by original Medicare Part A (hospital) and B (medical). The program pays Medicare premiums, covers Medicare co-pays and deductibles, and offers services not covered by original Medicare Part A and B such as dental coverage. The ABD program is available to individuals who are (a) aged (65 or older), blind, or determined disabled, (b) have limited income, and (c) limited resources.
Eligibility Criteria
To qualify for ABD Medicaid in New Jersey, applicants must meet specific financial and non-financial requirements.
- Aged, Blind, or Disabled: The program is open to individuals who are “Aged” – 65 years or older, Blind according to Social Security standards, or meet Social Security’s definition of Disabled, which generally requires a physical or mental condition that substantially limits one’s ability to work and is expected to last at least 12 months or result in death.
- Low Income: Income limits for ABD Medicaid are based on the Federal Poverty Level (FPL) and vary depending on household size. As of 2025, the income limit is 100% of the FPL, which is $1,304 for an individual and $1,763 for a married couple.
- Limited Resources: Applicants must have limited resources to qualify. For individuals, the resource limit is $4,000, and for couples, it is $6,000. Some assets, such as a primary residence, one vehicle, and personal belongings, are excluded from these limits.
- Citizenship and Residency: Applicants must be U.S. citizens or qualified non-citizens and reside in New Jersey.
Dual Eligibility for Medicare and Medicaid
Dual eligibility means that an individual receives benefits from both Medicare and Medicaid, which can significantly reduce out-of-pocket healthcare costs. Individuals 65 and over are required to enroll in Medicare, and low income individuals are often surprised when this happens because their primary insurance transitions from Medicaid to Medicare. Many even lose Medicaid access altogether because ABD Medicaid income and asset eligibility is much harder to meet than the ordinary New Jersey Family Care Medicaid that is available to people 64 and under. Nonetheless, Medicare recipients who meet the eligibility criteria outlined above can have access to both Medicare as their primary insurance and ABD Medicaid. Even those who don’t qualify for ABD Medicaid may still have access to a Medicare Savings Program, which can help cover Medicare premiums, deductibles, and co-pays.
How to Apply
Applying for ABD Medicaid in New Jersey involves several steps. Here’s a quick guide to help you through the process:
- Gather Necessary Documents – Before applying, collect all required documentation to support your application. This will include, Social Security disability determination letter, proof of income (pay stubs, Social Security award letters, etc.), asset statements (bank accounts, property deeds, etc.), proof of U.S. citizenship or qualified non-citizen status, proof of New Jersey residency (lease agreements, utility bills, etc.).
- Submit Your Application – You can apply for ABD Medicaid online, by mail, or in person at your county’s Board of Social Services.
- Respond to Requests for Additional Information – After submitting your application, you may be contacted for additional information or documentation. Be sure to respond promptly to avoid denial of the application or delays in processing.
What Happens After Approval?
Once approved, you’ll receive a state Medicaid ID card, as well as a card from the insurance company administering your benefits, also called a Managed Care Organization or MCO. You choose your MCO when filling out the application. New Jersey currently has 5 MCOs, including, Aetna Better Health of New Jersey, Fidelis Care, Horizon NJ Health, UnitedHealthcare Community Plan, and Wellpoint (formerly Amerigroup New Jersey).
You should keep your address updated with your MCO and the state because you must renew your Medicaid eligibility annually to ensure continued coverage. The state will send you a renewal notice with instructions.
What If You Don’t Qualify?
If your application is denied, you have the right to appeal the decision. You can request a Fair Hearing. You may also reapply, which is recommended if you did not provide necessary documentation in a timely manner or were ineligible at the time of the application, but now are eligible. Additionally, other programs, such as the Specified Low-Income Medicare Beneficiary (SLMB) or the Pharmaceutical Assistance to the Aged and Disabled (PAAD) programs, may help provide assistance with Medicare premium and drug costs.
Tips for a Successful Application
- Get Organized: Collect the documets you will need for the application before submitting the application.
- Stay Organized: Keep copies of everything you submit and all letters you receive in response. It is also a good practice to use cover letters listing the documents you are sending as well as responses to questions. Also make sure you date your letters to show when responses were sent.
- Seek Assistance: If you’re unsure about the process, contact your county’s Board of Social Services or a local advocacy group for help.
- Be Honest and Thorough: Provide accurate information to avoid delays or complications.
Conclusion
ABD Medicaid is a lifeline for many aged, blind, and disabled individuals in New Jersey. While the application process may seem daunting, understanding the eligibility criteria and following the steps outlined above can make it more manageable. For those who qualify for both Medicare and Medicaid, dual eligibility provides additional financial relief and expanded coverage, ensuring access to comprehensive healthcare services. If you have questions or need further assistance, don’t hesitate to reach out to your county’s Board of Social Services or explore online resources provided by the New Jersey Department of Human Services.