The Centers for Medicare & Medicaid Services (CMS) manages the social health programs called Medicare and Medicaid. These programs are specially designed to help disabled, senior, and low-income people afford health coverage. These two health insurances cover two different population sectors. Medicaid helps low-income individuals while Medicare benefits are available based on age or disability.
What happens if you’re someone who meets the criteria for both? Millions of individuals live on a fixed income, and this can qualify you for Medicaid coverage. Can you have both Medicare and Medicaid coverage, or do you have to choose one? If you qualify, you may be able to be a dual-eligible.
Medicare and Medicaid Team up to Provide Coverage
Many seniors in the United States have dual eligibility for Medicare and Medicaid benefits. Generally, this means that you have enrolled in Medicare, but that you qualify for Medicaid as well due to your income.
When you have dual enrollment, Medicare is your primary insurance that covers any costs first. Medicaid is your secondary payer. Every state has different benefits for people who qualify under dual eligibility, so it’s important that you check with your local Medicaid office.
Medicaid can cover a large variety of healthcare services like behavioral health for substance abuse and mental health or dental care. Medicaid also has a robust cost-sharing program that helps cover any out of pocket costs for economically disadvantaged participants. It can even help cover the cost of prescription drugs and long-term care facilities. In turn, dual beneficiaries get comprehensive coverage that meets all of their needs.
How Medicaid and Medicare Benefits Work Together
If you’re still not sure how Medicaid and Medicare can work together to give you coverage, this is for you. We’ve pulled a few popular ways dual beneficiaries use both of these coverages to their benefit. Many of them will use several of the listed ways, but some people may only use one or two.
Secondary Insurance
Medicaid can fill in the gap as a secondary insurance to Medicare. Any services you have that Medicare pays for like hospital care, doctor’s visits, skilled nursing facility care, or home care, Medicare will pay for as the primary payer. Medicaid always pays last, and it’ll pick up excess charges. When you visit a facility that takes both coverages, Medicare pays first. Medicaid can pick up copays and coinsurance payments.
Premium Payment Assistance
Medicaid can give you assistance in paying your Medicare premiums. In most instances, if you have dual coverage through Medicare and Medicaid, you’ll automatically enroll in a Medicare Savings Program (MSP). These savings programs will pay for your Medicare Part B premium cost, and they can offer additional payment assistance in other areas.
Cost Sharing Assistance
Medicaid can pay any cost-sharing charges you have. This help will depend on your income level. If the level is low enough, you could qualify for the Qualified Medicare Beneficiary (QMB) Medicare Savings Program. If you enroll in QMB, you won’t have to pay Medicare cost-sharing fees. These fees include copays, coinsurances, and deductibles because Medicaid will pay it.
Prescription Drug Assistance
Prescription drugs are some of the biggest expenses people on Medicare face, and Medicaid can help. People who meet the eligibility requirements for dual enrollment in Medicare and Medicaid automatically get enrolled in the Extra Help program. This program helps to cover the cost of prescription drugs they need through Medicare Part D.
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