The NC General Assembly has established income limits used to determine Medicaid eligibility. If the income of the family is more than the amount set by the General Assembly, there will be a deductible.
- For married couples, income of both are used to decide the deductible amount.
- For a child, the parent's income is used to decide the deductible amount.
You will be authorized for Medicaid on the date that the medical costs add up to the amount of the deductible. If you have a large medical expense or if you are close to meeting your deductible, take your bills to your county Division of Social Services caseworker as soon as you get them. Remember to keep receipts.
Meeting the Deductible
Unpaid medical bills and current medical expenses count toward meeting your deductible.
- For married couples, medical bills of both are counted toward the deductible.
- For a child, the parent's medical bills are counted.
Unpaid Medical Bills
An unpaid medical bill may be used to meet your deductible. It must be a Medicaid bill listed in "Current Medical Expenses." To use this bill, your caseworker must verify the following:
- The bill must be less than 2 years old.
- If the bill is more than 2 years old, you must have made a payment on it within the past two years.
- The bill must be unpaid and the medical provider is still billing you.
- All medical insurance you had at the time must have been filed, and either paid or denied payment for the bill.
- If you borrowed money to pay off a medical bill, let your caseworker know to determine if it can be used toward your deductible.
Current Medical Expenses
Current medical expenses that are your responsibility may be used to meet your deductible. Take your bills or receipts to your caseworker. Always ask the caseworker to make a copy of your bills so that you can keep the original for your records.
Medical expenses include:
- Hospital charges
- Clinic and laboratory charges
- Visits to the doctor, dentist or therapist
- Prescription drugs
- Over-the-counter drugs (those that do not require a prescription) such as pain relievers (e.g., aspirin, Tylenol, Advil; stomach/nausea relievers (e.g., Pepto-Bismol), allergy relievers (e.g., Benadryl) and cold medicines (e.g., Dayquil). You must keep the receipt.
- Medical supplies such as gauze, bandages, needles for medical injections, absorbent pads for the incontinent, rubbing alcohol
- Equipment such as dentures, eyeglasses, hearing aids, walkers, wheelchairs, crutches, braces
- Vitamins or supplements such as Ensure, if prescribed by your doctor
- Transportation to the doctor or hospital
Medical Assistance Operations Section