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Medicaid and Medicare are two distinct government-run programs that provide health coverage. While Medicare is generally for people over 65 or with certain disabilities, Medicaid serves low-income individuals and families.
Importantly, being eligible for Medicare does not automatically disqualify you from receiving Medicaid benefits. In fact, some individuals qualify for both programs simultaneously.
A significant overlap exists where approximately 12 million people are “dually eligible,” enrolled in both Medicaid and Medicare. This dual eligibility covers over 15% of all Medicaid enrollees, allowing them to receive comprehensive health coverage under both programs.
By federal statute, these dually eligible individuals can be covered for both optional and mandatory categories of services, ensuring a broad range of medical care and support.
This article will explore how Medicaid and Medicare can work together, the impact of different types of Medicare on Medicaid eligibility, and how one can apply for Medicaid.
If I Am on Medicaid, Does It Matter What Type of Medicare I Have?
When you are covered by both Medicaid and Medicare, Medicaid can often cover costs that Medicare does not, such as certain copayments, deductibles, and premiums.
The type of Medicare you have can affect the extent of coverage:
- Medicare Part A (Hospital Insurance): Typically free for most people, this doesn’t generally affect your Medicaid coverage.
- Medicare Part B (Medical Insurance): Medicaid can help pay your Medicare Part B premiums through Medicare Savings Programs if you qualify based on income and asset limits.
- Medicare Part D (Prescription Drug Coverage): For those with both Medicaid and Medicare, Medicaid will no longer pay for your prescriptions; however, you will likely be eligible for a Part D plan, including extra help with costs.
- Medicare Advantage (Part C): This replaces Parts A and B and sometimes includes Part D. It is important to choose a plan that aligns with your Medicaid benefits to ensure all possible expenses are covered.
Medicaid also extends additional services beyond what Medicare provides, such as nursing facility care beyond the 100-day limit or skilled nursing facility care covered by Medicare, along with prescription drugs, eyeglasses, and hearing aids.
For services covered by both programs, Medicare typically pays first, with Medicaid filling in the gaps up to the state’s payment limit.
How Can I Sign up for Medicaid?
To apply for Medicaid, you should visit the website for your state’s Medicaid program or submit an application through the Health Insurance Marketplace.
Here are the steps generally involved:
- Determine Eligibility: Check your state’s Medicaid website or contact a local agency to understand the eligibility criteria, including income level, family size, and more.
- Gather Necessary Documentation: You must provide proof of income, citizenship or legal residency, and other personal information.
- Submit an Application: This can typically be done online, by mail, or in person at a local Medicaid office.
- Review and Approval: After your application is reviewed, you will be notified of your eligibility and your coverage details.
Understanding the interplay between Medicaid and Medicare is crucial for maximizing your healthcare benefits, especially if you qualify for both. Navigating these programs can be complex, with various aspects affecting your coverage and the costs involved.
If you’re looking for expert guidance to navigate this landscape or need assistance in determining how to best integrate these benefits, CoverRight is here to help. Our team is dedicated to providing transparent, comprehensive advice to ensure you make the most informed decisions about your healthcare coverage.
FAQs
If I am on Medicare first, can I still get Medicaid?
Yes, being on Medicare does not preclude you from qualifying for Medicaid. Medicaid eligibility primarily depends on your income and asset levels, not on whether you are enrolled in Medicare.
This is particularly helpful as Medicaid can help cover additional costs that Medicare does not fully cover, such as copayments, deductibles, and extended nursing facility stays.
If I am on Medicare first, will I lose Medicare if I go on Medicaid?
No, qualifying for Medicaid will not cause you to lose your Medicare coverage. In fact, being enrolled in both programs can enhance your coverage. Medicare will continue to be your primary health insurance coverage provider, and Medicaid will act as a secondary insurer, helping to cover additional costs that Medicare does not, such as certain deductibles, copayments, and premiums that are part of your Medicare coverage.
This dual eligibility ensures a broader spectrum of healthcare services at lower out-of-pocket costs.
