How Might Lowering The Medicare Age Affect Medicaid Enrollees
President Bidens FY 2022 budget proposes lowering the Medicare enrollment age from 65 to 60, and a group of over 150 House Democrats recently a provision lowering the Medicare age to 60 or 55 to be included in the Presidents American Families Plan. President Bidens budget proposes giving people age 60 and older the option to enroll in the Medicare program with the same premiums and benefits as current beneficiaries, but with financing separate from the Medicare Trust Fund. The Presidents budget proposal does not detail how lowering the Medicare age would work or be financed, or how it would affect current Medicaid spending and enrollees. While lowering the Medicare eligibility age based solely on work history to 60 could provide coverage to older adults who are currently uninsured or provide a more affordable option for people with private health insurance coverage, it also could affect Medicaid enrollees in this age range. Some Medicaid enrollees might lose Medicaid coverage when they gain Medicare, and others might become dually eligible for both programs, depending on the details of how it would work.
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More Resources For Medicare Beneficiaries
When approaching the age to qualify for Medicare benefits, visit the official Social Security Administration Medicare website to determine your eligibility and calculate your premium. In the meantime, read more about when and how to apply for Medicare and visit medicare.gov to prepare for when that time comes.
The Difference Between Medicare And Medicaid And How People Can Get The Best Care
Medicare and Medicaid are two of the most important health insurance programs in the United States. They provide coverage for people over the age of 65, people with disabilities, and low-income families. Medicare is a government program, while Medicaid is a program run by the states.
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Who Can Get Medicaid
- No matter your state, you may qualify for Medicaid based on your income, household size, disability, family status, and other factors. But if your state has expanded Medicaid coverage, you can qualify based on your income alone.
- Enter your household size and state. We’ll tell you who is eligible for Medicaid, if your state expanded and if you qualify for Medicaid based only on your income.
- If you think you have Medicaid eligibility, you can create an account and fill out a Marketplace application. If it looks like anyone in your household qualifies for Medicaid or CHIP, we’ll send your information to your state agency. They’ll contact you about enrollment. You can apply any time of year.
- If you don’t qualify for Medicaid, we’ll tell you if you qualify for financial help to buy a Marketplace health plan instead.
Is Medicare Or Medicaid Primary
If you have both Medicare and Medicaid, Medicare is the primary insurer and will pay first. Medicaid will then pay second. Medicaid never pays first for services covered by Medicare. It will only pay after Medicare, employer group health plans, and/or Medicare Supplement insurance has paid.
However, there are some services Medicaid covers and Medicare does not, such as nursing home care. In this case, Medicaid would pay for the service and Medicare would only be primary payer for any Medicare-covered services received.
Medicaid will also help pay for other out-of-pocket expenses such as Medicare premiums, deductibles and copays.
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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.
Qualified Disabled & Working Individuals
Pays for the Medicare Part A premium if you are working, disabled, and under 65 OR if you lost your premium-free Part A when you went back to work. You must not be receiving state medical assistance. You also:
- Cannot exceed individual monthly income limit of $4,132
- Cannot exceed married monthly income limit of $5,572
- Cannot exceed individual assets limit of $4,000
- Cannot exceed married assets limit of $6,000
Access the Medicare Savings Program Application here.
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Medicaid Vs Medicare: You Can Have Both
Posted: January 17, 2020
Medicaid and Medicare. Its hard to think of two words that cause as much confusion.
- Whats the difference between these two government health insurance programs?
- What exactly are Medicaid and Medicare?
- Whos eligible to get Medicaid or to get Medicare?
- And how can some people get both?
Read on to find out the answers to these questions and more.
Medicare Extra Help Application
If you have Medicare but do not qualify for Medicaid, fear not! You may still qualify for financial assistance in another form: Medicare Extra Help.
Medicare Extra Help, otherwise known as LIS , helps you cover your prescription drug costs that Medicare does not cover. To qualify for Extra Help, you must first have Original Medicare . You cannot have savings, investments, and real estate that total more than $28,150 .*
*These numbers are subject to change every year.
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Are You Eligible For Medicare And Medicaid
If youre not sure whether or not you are eligible for Medicare and Medicaid, we can help. Give us a call and well ask you a series of questions to help you find out if youre eligible.
If you are eligible, we can send an agent to your home to help you sort through your health care options. Another perk of being eligible for both Medicare and Medicaid is that you can receive a Special Enrollment Period, meaning that you can make changes to your coverage during any time of the year and dont have to wait for the Annual Enrollment Period in the fall.
Our agents are licensed to sell plans from multiple different carriers, so they can help you pick the plan that truly works best for you.
To get started, give us a call at 1-833-438-3676 or .
This post was originally published on March 15, 2018, and was updated on September 28, 2018, and updated again on April 3, 2019.
Medicare Enrollment Can Be Impacted By Social Security Benefits
Depending on your situation, you with either need to enroll in Medicare at age 65 or you may be able to delay. If you continue to work past age 65 and have creditable employer coverage , you can likely delay enrolling in Medicare until you lose that employer coverage. In most cases, people turning 65 will need to get Medicare during their 7-month Initial Enrollment Period to avoid financial penalties for enrolling late. Your IEP begins 3 months before the month of your 65th birthday and ends 3 months after.
Social Security benefits fit in the Medicare enrollment journey in one special way. If you are receiving either Social Security benefits for retirement or for disability, or Railroad Retirement Board benefits, you will be automatically enrolled in Medicare Part A and Part B when you first become eligible.
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Medicare Vs Medicaid: Whats Next
Now that you understand the difference between Medicare and Medicaid, its time to take steps towards enrolment in your plan of choice.
Weve created a brief, informative eBook to help you understand everything that you need to know about Medicare. Please, take a moment to download it and review it. Our goal is to help you become more informed before making a very important decision that will impact your health for years to come. Our eBook will guide you towards taking the next steps. Were here to help at each step of the way, so you dont have to do this alone.
Medicare Eligibility For People Under 62
There are a few exceptions for Medicare age limits that can allow people younger than 65 and under age 62 to enroll in Medicare.
- If you have ALS , you are immediately eligible for Medicare regardless of your age as soon as your Social Security or Railroad Retirement Board disability benefits begin.
- You may also qualify for Medicare if you have kidney failure that requires dialysis or a kidney transplant, which is known as end-stage renal disease .
- You may also qualify for Medicare at age 62 or any age before 65 if you receive disability benefits from either Social Security or the Railroad Retirement Board for at least 24 months.
If you qualify for Medicare under the age of 65 because of a disability, you might also qualify for a Medicare Advantage Special Needs Plan.
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What Is Medicare Vs Medicaid
- A federal health insurance program for people who are:
- 65 or older
- Under 65 with certain disabilities
- Of any age and have End Stage Renal Disease or Amyotrophic Lateral Sclerosis
A joint federal and state program that helps pay health care costs for certain individuals and families with limited income and resources.
You May Qualify For Legal Assistance
Figuring out which healthcare plan will cover you can be confusing especially if you havent yet filed your disability claim. A local disability advocate can walk you through Medicare vs Medicaid coverage available in your state. Its almost impossible to tell whether youre eligible for healthcare assistance programs without first knowing your individual circumstances and location.
Ready to see if you may qualify? Click the button below to start your free online benefits evaluation now!
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How To Apply For Medicaid
If youâre eligible for Medicaid, you can apply all year round through your states Medicaid website or HealthCare.gov, the federal health insurance marketplace. If you apply for Medicaid through Healthcare.gov and it looks like you qualify, the federal government will notify your state agency, which will contact you about enrollment. States also generally let you print out paper applications you can mail, fax or return directly to your local government office.
To complete your Medicaid application, you will likely need to provide documentation that you meet your states requirements. This documentation may include:
Your birth certificate or drivers license to serve as proof of age and citizenship
Recent pay stubs or tax returns to serve as proof of income
Copies of bank statements
Proof of address, which could include a lease, utility bill statements or a copy of your mortgage
Medical records to serve as proof of disability
States have 45 days to process your Medicaid application. They have 90 days if eligibility is tied to a disability . Processing can take longer if applicants do not supply all of the required documentation. If you dont qualify for Medicaid, you might be able to get subsidized health insurance through Healthcare.gov. However, only certain life events allow you to apply for a marketplace health care plan outside of open enrollment, which takes place from Nov. 1 to Jan. 15.
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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.
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Dual Special Needs Insurance
Even better, some insurance companies offer Medicare insurance packages specifically designed to work with your Medicaid dual-eligible status.
How so? If you have certain chronic health conditions , you may be better served by one of the dual special needs Medicare insurance plans that have extra benefits to address those specific conditions.
Please Answer A Few Questions To Help Us Determine Your Eligibility
Disabled people who are approved for Social Security disability insurance benefits will receive Medicare, and those who are approved for Supplemental Security Income will receive Medicaid. However, SSDI recipients aren’t eligible to receive Medicare benefits until two years after their date of entitlement. For more information on calculating how this is calculated, see our article on when you’ll receive Medicare benefits. There is no waiting period for SSI recipients to receive Medicaid.
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Medicare Services & Fees
Eligible recipients of Medicare have a choice. They may enroll into either Original Medicare or into a private health plan known as Medicare Advantage . All plans cover the same basic Medicare-covered health services, but there are differences in premiums, deductibles, coinsurance and provider networks. People should carefully consider their own situations before choosing. If their needs change, people may also change plans during the Open Enrollment period each year.
People enrolling in Original Medicare should also consider enrolling in a stand-alone Prescription Drug Plan , also known as Part D, to cover their outpatient prescription drugs. Most Medicare Advantage Plans already cover prescription drugs.
Below is more detail on coverage provided by Medicare parts A, B, C and D:
Original Medicare members can also enroll in Medicare Supplement Insurance, also called Medigap, which fills in the gaps not covered by Original Medicare. Medigap is offered by private, approved insurance companies. These plans pay for costs such as coinsurance, copayments and deductibles.
In Connecticut, a Medigap cannot be used as a stand-alone plan, and is designed to be used in combination with Parts A and B. These plans do not provide prescription drug benefits. The state offers up to 10 standardized policy options, each labeled with a letter. All plans of the same letter offer the same benefits, no matter which insurance company offers the plan.
Using Medicaid With Medicare Or Other Medical Insurance
If you have both Medicare and Medicaid, they work together for you. Medicare pays first, and Medicaid pays last.
Medicare has two parts: Medicare Part A and Medicare Part B
Medicare Part A:
- Pays for skilled nursing care and hospital services.
- Pays for most of your hospital expenses.
Medicaid will pay most of the hospital bills that Medicare Part A doesnt pay. You may be billed for a small amount, called co-insurance. You might also have to pay part of the deductible for inpatient hospital care.
Medicare Part B:
- Pays for visits to the doctor
- Pays for lab tests and X-rays.
Not everyone on Medicare has Part B. You have to pay a small amount each month. Medicaid will pay this monthly charge for you. Let your DHS county office know you have Medicare Part B so you wont be charged a Medicare premium. Medicaid also pays most of the charges that Medicare Part B will not pay. You may be billed for a small amount.
If you have health insurance and Medicaid:
Other times when Medicaid will not pay until someone else pays:
- If you are hurt in a car accident, Medicaid will not pay until your car insurance or the other drivers car insurance has paid or denied payment.
- If you are hurt on the job, Medicaid will not pay until workers comp has paid or denied payment.
- If you win a lawsuit because you got hurt or you get a cash settlement from such a lawsuit, you must use the money to pay your medical bills. Medicaid will only pay toward any amount of your medical bills that are left over.
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Who Runs Medicare And Medicaid
The federal government runs the Medicare program. Each state runs its own Medicaid program. Thats why Medicare is basically the same all over the country, but Medicaid programs differ from state to state.
The Centers for Medicare and Medicaid Services, part of the federal government, runs the Medicare program. It also oversees each states Medicaid program to make sure it meets minimum federal standards.
Although each state designs and runs its own Medicaid program, all Medicaid programs must meet standards set by the federal government in order to get federal funds .
In order to make significant adjustments to their Medicaid programs, states must seek permission from the federal government via a waiver process.
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