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How Do Medicare and Medicaid Work Together?

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Key Takeaways

  • You have “dual eligibility” if you are accepted by both Medicare and Medicaid. Those who qualify for dual eligibility can use their Medicaid and Medicare benefits together to fill in coverage gaps and lower out-of-pocket expenses. It’s not something you’ll need to plan for separately.

  • Medicare coverage begins at age 65 for most seniors. Due to low income or limited resources, some seniors on a fixed income are also eligible for Medicaid. If you’re under 65 and receiving SSDI, you may be eligible for Medicaid and then Medicare after 24 months of SSDI payments or when you turn 65, whichever comes first.

  • Medicaid, health insurance programs, and benefits extend Medicare coverage and pay for expenses that Original Medicare does not.

  • You can enroll in Medicare on your own or with the help of our licensed insurance agents if you are dually eligible for Medicaid and Medicare.

Medicaid is a government health insurance program that helps cover medical costs and may help those who qualify but are having trouble affording necessary medical care. If you are considering Medicare, or if you are already on it but are having trouble paying for it, you should find out if you are eligible for Medicaid as well.

What’s the Difference Between Medicaid and Medicare?

Medicaid is a social welfare system. Medicaid enrollment is open all year for eligible individuals. Most people on Medicaid can’t afford comprehensive health coverage. Covered medical services are generally provided at no health care costs to Medicaid patients.

Those who qualify for Medicare receive coverage through the government’s health care insurance program. Seniors (aged 65 and up) make up the bulk of Medicare recipients. Deductibles and premiums are two ways in which patients contribute to their healthcare costs. Since Medicare is an agency of the federal government, its operation is standard throughout the country. Initial Medicare enrollment, the Medicare Open Enrollment Period, the Medicare Advantage Open Enrollment Period, and Special Enrollment Periods are the times of the year when you can sign up for Medicare.

Can You Have Medicare and Medicaid?

A quick yes is appropriate. A “dual-eligible beneficiary” is someone eligible for both Medicaid and Medicare. A person who is dual eligible may initially enroll in Medicaid and later become Medicare eligible, or vice versa. Medicaid helps low-income Medicare recipients, including seniors.

How does dual eligibility work?

Dual-eligible recipients are those who have:

It is always Medicare benefits that are paid first and Medicaid benefits that help cover any remaining costs.

Dual-eligible Medicare recipients will have their premiums and out-of-pocket costs covered by Medicaid. Costs, such as those associated with long-term care, are shared between Medicare and Medicaid. Medicare Savings Programs may help cover some of the costs if you do not qualify for full Medicaid benefits:

  • The QMB Program Identifies Medicare Recipients Who Are Qualified

  • Special Medicare Beneficiary (SLMB) Program

  • Program for Qualified Individuals

  • Program for Qualified Disabled Working Individuals

In some cases, Medicaid will also pay for medically necessary items like glasses and hearing aids. To the extent allowed by your state’s budget, Medicaid will pay for any Medicare-ineligible medical expenses you incur. You can get assistance with enrollment, finding available subsidies, and selecting the appropriate coverage from our licensed insurance agent. You can also look at the Medicaid website for your state to find out more.

What is Covered?

Medicaid services are governed by your state. Part A and Part B (medical insurance outside the hospital) are what make up Original Medicare. State governments, working within federal guidelines, are responsible for establishing Medicaid’s rules, regulations, and policies. All Medicare recipients in the United States receive the same basic level of coverage from Parts A and B, which are administered by the federal government.

Dual eligibility does not affect your Medicare Parts A and B benefits, but it may affect the amount of Medicaid you receive. Your income and assets will determine whether you have “partial” or “full” dual eligibility. Medicare Parts A and B premiums, deductibles, and coinsurance may be partially covered by Medicaid. The benefits of full coverage are the same as those of partial coverage, and they may also extend to long-term care services that Medicare does not pay for.

What are my Costs with dual eligibility?

Payouts can be minimized for beneficiaries who qualify for both programs. Fortunately, state Medicaid programs ensure that many Medicare recipients will incur no financial responsibility for their healthcare. As the primary insurer, Medicare pays 100% of Medicare-approved costs for covered services. Medicaid will cover any additional costs for necessary medical care that are not covered by Original Medicare.

Can you have both Medicare and Medicaid in NY?

IB-Dual allows Medicare-eligible members to keep their current mainstream Medicaid managed care health plan. If you are dually eligible, your current health insurance will cover both Medicaid and Medicare for you.

What is dual-eligible Medicare Medicaid in Florida?

If you are eligible for both Medicare and Medicaid, you may be interested in enrolling in a Dual Eligible Special Needs Plan (D-SNP), which is a type of Medicare Advantage plan (Part C: offered by private insurance companies).

Who is eligible for Medicare and Medicaid?

Medicare is a federal program that provides health coverage if you are 65 or older or under 65 and has a disability, no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income.

Is Medicaid free?

Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

What are the disadvantages of Medicaid?

Disadvantages of Medicaid

They will have a decreased financial ability to opt for elective treatments, and they may not be able to pay for top-brand drugs or other medical aids. Another financial concern is that medical practices cannot charge a fee when Medicaid patients miss appointments.

What is the lowest income to qualify for Medicaid?

Federal Poverty Level thresholds to qualify for Medicaid

The Federal Poverty Level is determined by the size of a family in the 48 states and the District of Columbia. For example, in 2022, it was $13,590 for a single adult, $27,750 for a family of four, and $46,630 for a family of eight.

FAQs

Does Medicare include prescription drug coverage?

Everyone with Medicare has access to prescription drug coverage. The name of this insurance is “Part D.”

What triggers higher Medicare premiums?

You will pay higher rates for your Part B and Medicare prescription medication coverage if you file your taxes as “married, filing jointly” and your MAGI is more than $194,000. You will pay higher premiums if you file your taxes under a different status and your MAGI is more than $97,000.

Can a married couple both receive joint federal social security benefits?

Depending entirely on their own individual earnings histories, each couple is eligible to claim their own retirement payout. Both of you are eligible to get your full amounts simultaneously. However, if you receive spousal benefits, the income of your husband may have an impact on the total amount of Social Security you receive.

Does Medicare Plan B cover dental services?

Primary Medicare Except for limited conditions, dental treatment is not covered by Parts A or B. For instance, Part A will pay for your inpatient expenses if you need dental surgery while you are in the hospital. You are responsible for covering the full cost of all other dental procedures, including cleanings and root canals.

What is the lowest income for Medicaid eligibility?

Minimum Federal Poverty Levels Need to Be Medicaid Eligible

For the lower 48 states and the District of Columbia, the size of a family determines the federal poverty level. For instance, in 2022, a single adult will pay $13,590, a family of four will pay $27,750, and an eight-person family will pay $46,630.

 

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