Medicare And Medicaid: How To Qualify For Both
Home / FAQs / General Medicare / Medicare and Medicaid: How to Qualify for Both
Medicare and Medicaid are different programs. Depending on your healthcare and financial situation, its possible to have both. But, just because you have one, doesnt mean youll automatically have the other. Medicare is a federal program, while Medicaid is a state program.
How Do You Qualify For Medicaid
You qualify for Medicaid based on your finances. Medicaid needs to see difficulties with one of two things:
What are the income requirements?
Medicaid is primarily a state-run program. Each state runs its own Medicaid program the way it sees fit. They also set local financial standards to receive Medicaid benefits.
Thats why you may qualify for Medicaid benefits when you apply, but your friend with similar income and assets who lives in a different state doesnt. It all depends on where you live.
Medicaid has two funding sources: the state and the federal government. Therefore, the money to operate Medicaid is split between the federal governments contribution and the taxes a state collects.
Keep in mind that annual income limits for Medicaid are indexed to the federal poverty level. In 2021, the limit in the continental U.S. was $12,880 for an individual and $17,420 for a couple.
If You Qualify For Both Medicare And Medicaid You’re What’s Known As Dual Eligible
Medicare provides medical coverage and benefits to people age 65 or older, or who have a qualifying disability. Medicaid is a federal and state program that helps with medical costs for some people with limited income and resources, and also offers benefits not normally covered by Medicare.
In most cases, even if you have Medicaid, you must enroll in Medicare when youre eligible. This is because Medicare is the primary insurance and will provide benefits and coverage for health care services you need. If you do not enroll when youre eligible, you may face a late enrollment penalty.
That said, you are able to be enrolled in both Medicare and Medicaid at the same time, and just because you become eligible for Medicare does not mean youll lose Medicaid. This is called dual eligibility, and more than 12 million people are dual eligible each year.
Understanding when youre eligible, how to be eligible, and how Medicare and Medicaid work together can help bring clarity to your health care coverage needs.
Don’t Miss: Does Medicare Cover Disposable Briefs
Can I Decline Medicare Altogether
Medicare isnt exactly mandatory, but it can be complicated to decline. Late enrollment comes with penalties, and some parts of the program are optional to add, like Medicare parts C and D. Medicare parts A and B are the foundation of Medicare, though, and to decline these comes with consequences.
The Social Security Administration oversees the Medicare program and recommends signing up for Medicare when you are initially eligible, even if you dont plan to retire or use your benefits right away. The exception is when you are still participating in an employer-based health plan, in which case you can sign up for Medicare late, usually without penalty.
While you can decline Medicare altogether, Part A at the very least is premium-free for most people, and wont cost you anything if you elect not to use it. Declining your Medicare Part A and Part B benefits completely is possible, but you are required to withdraw from all of your monthly benefits to do so. This means you can no longer receive Social Security or RRB benefits and must repay anything you have already received when you withdraw from the program.
Medicaid Recipients And The $50000 Pip Option
Under the new auto no-fault law, recipients of Medicaid can select a $50,000 PIP medical expense option. This option is only available if:
Does Medicaid Cover Auto Accident Injuries Under the New Law?
If you are considering opting for this level of PIP coverage, it is absolutely crucial you first understand which services are not available through Medicaid but may be needed in the event of an auto accident. Again, CPAN has created a remarkable brochure for consumers to compare coverages.
Please visit .
Don’t Miss: How Does Medicare Supplement Plan G Work
Can You Have A Medicare Advantage Plan And Medicaid At The Same Time
Medicare Advantage plans are Medicare plans offered by private insurers, while Medicaid provides health coverage for low-income eligible Americans. In some cases, you can have both at the same time if you qualify for dual eligibility.
- V.
What you should know
| 1. Medicare Advantage is a private Medicare plan, also referred to as Medicare Part C or MA plans. | 2. Medicaid is offered to those who meet low-income eligibility and covers additional health services that are not covered by Medicare. |
| 3. Dual eligibles can have both Medicare Advantage and Medicaid at the same time. | 4. Private healthcare providers offer specialized plans for dual eligibles that can coordinate Medicaid benefits with a Medicare Advantage plan. |
For those who meet income eligibility, Medicaid can be an important resource for covering healthcare expenses that Medicare does not. In addition, some people can benefit from having both Medicaid and Medicare Advantage, which is Medicare coverage through private insurance companies. Those who qualify are known as dual eligibles. Learn more about how it works.
Do You Need Medicare Part B
Ever wonder if you really need Medicare Part B? For most people over 65 the answer is: Yes, you need to enroll in Part B and you should do so when first eligible. If you miss your Part B deadline, you could be subject to penalties. Check out our Medicare deadline Calculator here
When to enroll in Medicare Part B largely depends on whether you has qualifying job-based or retirement insurance that can act in place of Part B. If so you may be able to waive Part B due since you have credible coverage through work. If you dont have access to credible coverage from a work or spouse, it is usually recommended that you enroll in Medicare Part B when first eligible .
Even if you have retirement insurance, you may still have to enroll in Part B. Most retirement programs require it. Check with your HR team and confirm your situation. Make sure that if you waive Medicare Part B due to retirement insurance, that you are not subject to Part B penalties if you enroll later.
For those who have retirement coverage, You have 8 months to enroll in Medicare once you stop working OR your employer coverage ends . If you do not enroll in Part B within 8 months of losing your coverage based on current employment, you may have to pay a lifetime late enrollment penalty and have a gap in coverage.
Also Check: Do I Need To Pay For Medicare
Recommended Reading: Does Medicare Cover Dexcom G6
Why Coordinate Medicaid And Snap Renewals
About three-quarters of SNAP households had at least one member receiving Medicaid or CHIP in 2014. To qualify for SNAP, households generally must have gross income below 130 percent of the poverty line. Medicaid eligibility varies among states and types of participant. In states that have expanded Medicaid for adults under the ACA, the minimum eligibility threshold is 138 percent of the poverty line. In most states that havent expanded Medicaid, adults without children arent eligible at all and parents are eligible at lower income levels. Children in all states are eligible for either Medicaid or CHIP at income levels higher than the SNAP eligibility threshold.
Similarities also exist between SNAPs and Medicaids processes for applying and determining eligibility. Households newly applying for Medicaid and/or SNAP must submit an application with information on who is in the household, their citizenship and immigration status, and what income they receive. State or county eligibility workers verify that information using available data sources as well as documentation the applicant submits, such as pay stubs. After approval, participants must report certain changes in their income or household situation, and states periodically renew eligibility by examining information the participants report as well as available data sources to determine if households remain eligible.
Can I Get Medicaid Prescription Drug Coverage
While prescription drug coverage is an optional Medicaid benefit , all states in America provide Medicaid drug coverage to eligible beneficiaries.
Beneficiaries who are eligible for both Medicaid and Medicare can get Part D prescription drug coverage through the Medicare Extra Help program or a Medicare Special Needs Plan. We explain more about each of those programs below.
There are certain types of prescription drugs that are typically not covered by Part D plans but may be covered by Medicaid.
These include drugs for:
Contact your state Medicaid program for information about Medicaid eligibility and enrollment.
Recommended Reading: How Do I Know If I Have Part D Medicare
What Does Medicare And Medicaid Pay For
Medicaid is known as the payer of last resort. As a result, any health care services that a dual eligible beneficiary receives are paid first by Medicare, and then by Medicaid. For full dual eligible beneficiaries, Medicaid will cover the cost of care of services that Medicare does not cover or only partially covers . Such services may include but are not limited to:
- Nursing home care
- Dental services
- Eye examinations for prescription glasses
The financial assistance provided to partial dual eligible beneficiaries is outlined in the table above.
Medicare For Ssi Recipients
Do you get Medicare coverage if you were approved for SSI? Claimants who are approved for SSI only typically receive Medicaid coverage in most states. And like SSI, Medicaid is subject to income and asset limitations. Medicaid is a needs-based, state- and county-administered program that provides for a number of doctor visits and prescriptions each month, as well as nursing home care under certain conditions.Can you ever get Medicare if you get SSI? Medicare coverage for SSI recipients does not occur until an individual reaches the age of 65 if they were only entitled to receive monthly SSI disability benefits. At the age of 65, these individuals are able to file an “uninsured Medicare claim,” which saves the state they reside in the cost of Medicaid coverage. Basically, the state pays the medical premiums for an uninsured individual to be in Medicare so that their costs in health coverage provided through Medicaid goes down.
For people with limited income and assets, Medicare offers “Extra Help” for prescription drug costs. This Extra Help covers the costs of a Medicare prescription drug plan — including monthly premiums and prescription co-pays. The application is online at www.socialsecurity.gov/prescriptionhelp. For more information, see Nolo’s article on the Extra Help subsidy.
Recommended Reading: Is Medicare Automatically Deducted From Social Security
What Are Medicare Special Needs Plans
If you are eligible for both Medicare and Medicaid, you may also be eligible to join a Dual-eligible Special Needs Plan . This is a certain type of Medicare Advantage plan that offers all of the same coverage as Medicare Part A and Part B along with additional benefits that are tailored to the needs of someone with limited income and resources.
All Medicare Advantage Special Needs Plans must include coverage for prescription drugs.
Learn more about Medicare Special Needs Plans and D-SNPs, and find out if there are any plans available where you live. You can compare Medicare plans online, including what drugs they cover and what pharmacies are part of the plan network. You can also call to speak with a licensed insurance agent to learn more.
If I Have Other Health Insurance Do I Need Part B
65 Incorporated came across this question from a Medicare beneficiary.
I just heard that if I have other insurance, I need only Medicare Part A. Part B is not necessary. Is this true?
It depends on the type of insurance an individual has. If the insurance is a COBRA or individual policy, or retiree coverage provided by a union or employer, enrollment in both Part A, hospital insurance, and Part B, medical insurance, is necessary. These types of insurance are secondary to Medicare, paying for any covered care after Medicare has paid its share.
But if the insurance comes through current employment of either the beneficiary or his or her spouse with a large employer , Medicare recommends enrollment in premium-free Part A. Part B enrollment is not necessary. When this coverage ends, Medicare provides special periods to enroll in Part B and obtain other coverage, such as a Part D prescription drug plan, a Medigap policy, or a Medicare Advantage plan.
Medicare out-of-pocket costs
Nearly three-fourths of middle-income Boomers under age 65 do not know that Medicare comes with out-of-pocket costs.
Think you know Medicare? Put your knowledge to the test!
Medicare is a national health insurance program that covers millions of people and involves an even greater number of healthcare providers and services. Its size alone invites confusion and misinformation. Find out if you can identify Medicare fact from fiction.
You May Like: What’s Wrong With Medicare Advantage
Medicare And Medicaid Whats The Difference Are They State Or Federal Programs
Before we get into Medicare Advantage vs. Medicaid, here are some brief basics on Medicare and Medicaid.
Medicare and Medicaid have the same âparentâ agency: the Centers for Medicare & Medicaid Services.
As you might already know, Medicare is a government health insurance program. Itâs mainly for people aged 65 or older, but some people qualify by disability before age 65. âOriginal Medicareâ is made up of Medicare Part A and Part B .
Medicare has four parts:
- Part A: Helps pay for hospitalization costs
- Part B: Helps pay for physician services, lab and x-ray services, durable medical equipment, and outpatient and other services
- Part C: Medicare Advantage plan offered by private companies approved by Medicare to provide at least the same benefits as Original Medicare Part A and Part B .
- Part D: Stand-alone Medicare Part D prescription drug plans and Medicare Advantage prescription drug plans offered by private companies approved by Medicare to assist with the cost of prescription drugs.
Medicaid is also a government health insurance program, but those who qualify generally have low incomes or disabilities, and donât have to be over 65 years old. Medicaid is administered by the states, but must follow certain federal rules.
Q How Long Will My Medicaid Benefits Remain Active
A. Medicaid is based on month to month eligibility. However, your benefits are redetermined on a yearly basis by DMMA to confirm whether you still remain eligible for the program you are receiving. Certain Medicaid programs require you to report changes in your situation within 10 days of the change. One example of a change that must be reported is new employment.
Don’t Miss: Does Aetna Medicare Advantage Have Silver Sneakers
How Can I Protect My Money From Medicaid
5 Ways To Protect Your Money from Medicaid
Legislation Aims To Make Medicare More Affordable For Lower
The Improving Medicare Coverage Act, introduced in the U.S. House in September by Washington Representative Pramila Jayapal, would do away with cost-sharing and premiums for Medicare beneficiaries with income up to 200% of the poverty level .
This bill, or something like it, would eliminate the current sticker shock that can go along with the transition from expanded Medicaid to Medicare. If you have an opinion on the legislation, you can reach out to your elected officials to speak with them about it.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health marketplace updates are regularly cited by media who cover health reform and by other health insurance experts.
Recommended Reading: Are Medicare Premiums Based On Income
Medicare Advantage And Medicaid Whats The Difference
The Medicare Advantage program is considered a âpartâ of Medicare â Medicare Part C. If you qualify for both Medicare and Medicaid, you can generally sign up for a Medicare Advantage plan. Or, you might want to look into the Medicare Savings Programs described above.
Many people prefer Medicare Advantage plans as a way to get their Medicare coverage. Medicare Advantage is a program that lets you get your Medicare Part A and Part B benefits through a private, Medicare-approved insurance company. Many plans have extra benefits, too, like prescription drug coverage and routine dental care.
Can I Get Medicare Or Medicaid While Receiving Social Security Disability Payments
After being approved for disability benefits, whether you receive Medicaid or Medicare will depend on whether youre also getting SSI or SSDI benefits. Those who qualify for Supplemental Security Income are eligible for Medicaid, while those who receive Social Security Disability Insurance qualify for Medicare. However, SSD recipients wont receive medical benefits from Medicare until two years after their application has been approved. Those who receive SSI dont have to wait before receiving Medicaid. Lets take a closer look at SSI, SSDI, and Medicare/Medicaid.
Recommended Reading: Does Medicare Cover In Home Care For Seniors
When To Enroll In Medicare If I Am Receiving Disability Benefits
If you are under 65 and receiving certain disability benefits from Social Security or the Railroad Retirement Board, you will be automatically enrolled in Original Medicare, Part A and Part B, after 24 months of disability benefits. The exception to this is if you have end-stage renal disease . If you have ESRD and had a kidney transplant or need regular kidney dialysis, you can apply for Medicare. If you have amyotrophic lateral sclerosis , you will automatically be enrolled in Original Medicare in the same month that your disability benefits start
You May Like: Do Medicare Advantage Plans Cover Chemotherapy
