Can I have both Medicare and Medicaid?
If I’m eligible for both Medicare and Medicaid, how do the two programs work together?
If you’re eligible for both Medicare and Medicaid, you’re considered “dual eligible”, and the two programs work together to help cover your healthcare costs. Each program serves different purposes, but when combined, they can provide comprehensive coverage for medical services, prescription drugs, and long-term care. Here’s how Medicare and Medicaid work together:
1. What Each Program Covers:
Medicare: Primarily covers healthcare services for people aged 65 and older, or those under 65 with certain disabilities. Medicare is divided into:
Part A: Hospital insurance (covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care).
Part B: Medical insurance (covers outpatient care, doctor’s visits, preventive services, and durable medical equipment).
Part D: Prescription drug coverage (helps cover the cost of prescription medications).
Medicaid: Provides health coverage for people with low income and limited resources. Medicaid covers a broader range of services than Medicare, including:
Long-term care services (such as nursing home care and personal care services).
Prescription drugs, if not covered by Medicare.
Additional services not typically covered by Medicare, like vision, dental, and hearing care (depending on your state).
2. How Medicare and Medicaid Work Together:
Medicare Pays First: When you’re dual eligible, Medicare acts as your primary insurance. This means Medicare pays first for most covered medical services, including doctor’s visits, hospital stays, and outpatient care.
Medicaid Pays Second: Medicaid acts as your secondary insurance and may cover costs that Medicare doesn’t pay, such as deductibles, copayments, coinsurance, and additional services (like long-term care). Medicaid can help fill the gaps in Medicare coverage, reducing your out-of-pocket expenses.
3. Medicare and Medicaid Coverage for Prescription Drugs:
Medicare Part D covers prescription drugs for dual-eligible individuals. Medicaid may help cover the Part D premiums and copayments for prescription medications, making them more affordable.
If you qualify for both programs, you will automatically qualify for Extra Help with your Part D prescription drug costs. This means you’ll pay lower premiums, deductibles, and copayments for your medications.
4. Medicare Savings Programs (MSPs):
If you’re dual eligible, you may also qualify for a Medicare Savings Program (MSP) through Medicaid. These programs help pay your Medicare Part A and/or Part B premiums, as well as other out-of-pocket costs like deductibles and coinsurance. The specific program you qualify for depends on your income and resources:
Qualified Medicare Beneficiary (QMB): Covers Part A and Part B premiums, deductibles, coinsurance, and copayments.
Specified Low-Income Medicare Beneficiary (SLMB): Covers Part B premiums.
Qualified Individual (QI): Covers Part B premiums.
Qualified Disabled and Working Individuals (QDWI): Helps pay Part A premiums for certain disabled individuals.
5. Long-Term Care and Medicaid:
One of the key benefits of Medicaid is its coverage of long-term care services that Medicare doesn’t cover. This includes:
Nursing home care.
Home and community-based services (such as personal care aides, homemaker services, and adult daycare).
If you need long-term care, Medicaid may cover the full cost or help with costs that Medicare doesn’t pay.
6. Copayments and Cost Sharing:
For most Medicare-covered services, Medicaid helps cover cost-sharing amounts (such as copayments, coinsurance, and deductibles). Depending on the state you live in, Medicaid may cover these costs fully, meaning you may have little to no out-of-pocket costs for Medicare-covered services.
7. Dual Special Needs Plans (D-SNPs):
Another option for dual-eligible individuals is enrolling in a Dual Special Needs Plan (D-SNP). D-SNPs are a type of Medicare Advantage plan specifically designed for people eligible for both Medicare and Medicaid. These plans often offer additional benefits beyond what Medicare and Medicaid cover separately, including:
Extra coverage for vision, dental, and hearing services.
Care coordination to help manage your healthcare.
Prescription drug coverage.
Low or no premiums, with cost-sharing assistance from Medicaid.
8. How to Enroll in Both Medicare and Medicaid:
You will need to apply for Medicare through the Social Security Administration if you’re eligible due to age or disability.
Medicaid eligibility and benefits vary by state, and you’ll need to apply through your state’s Medicaid office. If you’re eligible for Medicaid, you may automatically be enrolled in programs that help cover Medicare costs.
Key Takeaways:
Medicare is your primary insurance, covering hospital care, medical services, and prescription drugs. Medicaid is your secondary insurance, helping with costs Medicare doesn’t cover and providing additional benefits like long-term care.
You may also qualify for Medicare Savings Programs (MSPs) to help cover your Medicare premiums and cost-sharing.
Dual Special Needs Plans (D-SNPs) can offer additional benefits beyond Medicare and Medicaid.
For personalized help navigating your dual eligibility for Medicare and Medicaid, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
