When you qualify for Medicare and Medicaid , you are dual eligible. Dual eligibility allows beneficiaries to combine Medicare and Medicaid benefits to expand coverage and assist with costs. It is not a separate plan.
Medicaid usually pays all qualified medical service costs for low-income individuals and families. For dual-eligible beneficiaries, Medicare always pays first. Medicaid may cover expenses not covered by Medicare.
You do not have medical expenses because Medicare and Medicaid send payments to your providers.
Whether you’re new to Medicaid or one of 70 million people in a program, we have answers. Let’s begin with the basics: what is the difference between Medicaid and Medicare, and who can enroll in both?
Find a local Medicare plan that fits your needs
Medicaid is a program that assists with health insurance costs. The program serves people that qualify based on a low income. Medicaid recipients usually do not pay the costs of covered medical services. When it is time to enroll, it is essential to know that Medicaid is a federal-state program. This means your state runs the program but must follow federal guidelines.
Medicare is a public health insurance program. Most people that use Medicare are 65 years of age or older. Beneficiaries pay part of their medical costs through premiums, deductibles, and co-insurance. Medicare is a federal program, and care plans are usually standardized everywhere in the United States.
Dual-eligible beneficiaries can enroll in Medicare Part A , Medicare Part B , or both. They also can enroll in full Medicaid benefits or their state’s Medicare Savings Programs. If enrolled in both, your Medicare benefits always pay first, and Medicaid benefits assist with costs not fully covered by Medicare.
To qualify for both, you must meet federal requirements for Medicare, and then meet state-specific requirements for the Medicaid program.
Are you eligible for cost-saving Medicare subsidies?
You can qualify for both Medicaid and Medicare, and enrolling in both is dual eligibility. To apply for Medicare and Medicaid, it takes only a simple application. You can apply for Medicare online or over the phone. Then, you can complete Medicaid applications in person, by phone or online.
Once enrolled, you can change your plan once every calendar quarter for the first three quarters. All changes are active on the first day of the following month.
- January 1 – March 31
- April 1 – June 30
- July 1 – September 30
Fourth-quarter changes must be made during the Annual Enrollment Period (AEP) between October 15 and December 7. Fourth-quarter changes take effect on January 1.
Medicaid does not pay money to you if you qualify. Medicaid sends payments to your health care provider after you receive services. Depending on your state’s program, you may be responsible for paying a small copayment (part of the cost) for some medical services.
What extra benefits and savings do you qualify for?
The first thing you need to do is find out if you are eligible . You must be a resident of the state where you apply for the Medicaid program. Visit your state Medicaid site for information on eligibility, coverage and more. You can apply with your state Medicaid agency in person, over the phone or online.
Every state has a list of benefits that are required to be covered and others that are optional. We recommend that you contact your state Medicaid agency to learn more about what is and is not covered.
Because Medicaid is a state-federal program, it is not nationally standardized. Eligibility can vary from one state to another. We recommend you contact your state Medicaid agency if you have questions. You may also find out by applying.
The difference is that Medicaid covers nursing home care, while Medicare does not fully cover it. Part A will cover up to 100 days of Skilled Nursing facility care; days 21-100, you must pay a daily co-payment. However, if you have a Medigap policy, then that copayment will be covered.