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Can you have both Medicare and Medicaid?

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Just the Essentials…

  • While both Medicare and Medicaid are government-regulated health insurance programs, the groups of people they are designed to cover and the level of coverage provided can vary quite dramatically.

  • It is possible to have both Medicare and Medicaid coverage in certain situations.

  • Individuals who qualify for both Medicare and Medicaid are known as “dual eligible” and are likely to have most of their healthcare needs covered in some form.

  • If you are dual eligible for Medicare or Medicaid, you may be interested in enrolling in a Medicare Advantage plan, which can provide even more comprehensive coverage at a lower cost.

What is the difference between Medicare and Medicaid?

If you’ve ever been confused about the differences between Medicare and Medicaid, you are not alone. Simply put, both Medicare and Medicaid are government-regulated health insurance programs that help to provide healthcare service and treatment to millions of Americans, but each program has slightly different rules of eligibility and provides different coverage to different groups of people.

Medicare

Medicare is a health insurance program that is designed to help seniors and certain qualifying disabled individuals pay for their health care costs. 

Medicare is regulated and managed by the U.S. Federal government and typically provides coverage for hospital visits, doctor’s appointments, preventative care, and durable medical equipment. It is also possible to expand your Medicare coverage to include vision, dental, hearing, prescription drug, and even transportation benefits.

To be eligible for Medicare, you must meet the following criteria: 

  • Be 65 years of age or older or have been recently diagnosed with certain diseases or disabilities, such as End Stage Renal Disease.
  • You or your spouse have worked and paid Medicare taxes for at least 10 years over the course of your lifetime.
  • You are currently receiving retirement benefits from Social Security or the Railroad Retirement Board
  • You are eligible to receive Social Security or Railroad Retirement Board benefits but have not yet filed for them.
  • You have been entitled to Social Security or Railroad Retirement Board benefits for 24 months.
  • You or your spouse have had Medicare-covered government employment.

Medicaid

Medicaid is also a government-regulated health insurance program, but this program is managed jointly by both the U.S. federal government and individual state governments. 

As a result, Medicaid coverage varies from state-to-state. Typically, however, Medicaid is designed to provide health insurance coverage for highly specialized groups of low-income individuals, including: 

  • Those aged 65 and older
  • Children under 19 years of age
  • Pregnant women
  • Those with qualifying disabilities
  • A parent or guardian caring for a child
  • An adult without dependent children (most states)

Medicaid typically provides coverage for doctor’s visits, hospital days, long-term healthcare services, preventative care, mental health services, and prescription medication. Children covered under Medicaid may also receive vision and dental coverage. You can find out if you are eligible for Medicaid right here.

Is it possible to be eligible for both Medicare and Medicaid?

It may come as a surprise to many, but the answer to this question is yes: it is indeed possible to qualify for both Medicare and Medicaid simultaneously. This status is known as dual eligibility, and may give you access to more comprehensive benefits than you otherwise would have.

If you are a dual eligible individual, you are likely to have most of your healthcare services covered in some form with little-to-no out-of-pocket costs. Dual eligible individuals account for about 20 percent of Medicare beneficiaries, and are classified into two separate categories.

Full-Benefit Dual Eligibility

Full-benefit dual eligibles are individuals who have access to comprehensive Medicaid coverage and are also enrolled in Medicare coverage. Remember that Medicaid eligibility requirements vary by state, so it is important to refer to your state’s guidelines before exploring your possible benefits under dual eligibility. 

Generally, however, people who qualify for full dual eligible coverage are recipients of Supplemental Security Income (SSI), which provides financial assistance to low-income elderly and disabled individuals.

To qualify for SSI, you must be under a specified income limit (As of 2021: $794 per month for an individual or child, and $1,191 for a couple) and your assets must be considered limited (As of 2021: $2,000 for an individual or child, $3,000 for a couple).

Countable assets include:

  • Checking and savings accounts
  • Stocks and Bonds
  • Real Estate (not counting your primary residence)
  • Vehicles (if you own more than one)

Partial-Benefit Dual Eligibility

Typically, those who are considered partial-benefit dual eligibles do not receive full Medicaid coverage and usually fall into one of the following Medicare Savings Program (MSP) categories:

Qualified Medicare Beneficiary (QMB) Program

QMBs help pay for Medicare Part A and B premiums, deductibles, coinsurance, and copayments. Monthly income limits for 2021 are $1,094 for an individual and $1,472 for a couple (slightly higher in Alaska and Hawaii). Asset limits are $7,970 for an individual, $11,960 for a couple.

Specified Low-Income Medicare Beneficiary (SLMB) Program

SLMBs help pay for Medicare Part B premiums only. Monthly income limits for 2021 are $1,308 for an individual and $1,762 for a couple (slightly higher in Alaska and Hawaii). Asset limits are $7,970 for an individual and $11,960 for a couple.

Qualifying Individual (QI) Program

QIs help pay for Medicare Part B premiums only. As of 2021, monthly income limits are $1,469 for an individual and $1,980 for a couple (slightly higher in Alaska and Hawaii). Asset limits are $7,970 for an individual and $11,960 for a couple.

Qualified Disabled and Working Individuals (QDWI) Program

The QDWI program helps pay for Medicare Part A premiums only. For 2021, monthly income limits are $4,379 for an individual and $5,892 for a couple. Asset limits are $4,000 for an individual and $6,000 for a couple.

If I am a dual eligible beneficiary, what are my options for healthcare insurance plans?

Those who qualify for both Medicare and Medicaid have a lot of options for how they may wish to receive their health insurance plan and how their healthcare treatments and services are delivered.

The number of options always varies at the state level, but generally, dual eligible individuals can choose to receive health insurance coverage through the following:

Original Medicare

Dual eligible individuals may wish to receive healthcare coverage through Original Medicare Parts A and B. If so decided, the beneficiary would receive Part A and Part B coverage directly with Medicaid serving as a “wrap around” coverage that pays for services that Original Medicare does not cover.

Medicaid Managed Care

Some states choose to deliver dual eligible care through a Medicaid managed care program, which is similar to Medicare Advantage in that states are contracted with private insurance carriers to provide covered services.

Dual Eligible Special Needs Plans (D-SNP)

D-SNPs may be available to dual eligible individuals in certain states. These plans are specifically designed to coordinate the care of dual eligible enrollees, many of which focus on specific chronic conditions, such as chronic heart failure, diabetes, dementia, or End Stage Renal Disease.

Programs of All-Inclusive Care for the Elderly (PACE)

PACE plans provide medical and social services to a myriad of elderly individuals, most of whom are dual eligible. PACDE operates as a sort of “home-health” model where a multi-faceted team of healthcare professionals work together to provide coordinated care to an individual from the comfort of their very own home or community.

Medicare Advantage Plans (Medicare Part C)

It is also possible to opt to receive dual eligible healthcare coverage through a comprehensive Medicare Advantage plan. Medicare Advantage plans provide every benefit of Original Medicare, plus additional coverage like hearing, vision, dental, prescription drug, and transportation services. 

Just like with Original Medicare, Medicaid can offer “wrap-around” coverage to help you pay for copayments and coinsurance that are not covered by your plan.

At MedicareInsurance.com, we employ an experienced and friendly team of licensed health insurance agents whose primary goal is helping you find the coverage you need. When you enroll in a Medicare Advantage plan, you may receive even greater benefits at a lower cost, especially if you are dual eligible for both Medicare and Medicaid.

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