Menu
Call Us

How to Enroll in Medicaid and Have Medicare Coverage, Too

Learn Dual Eligibility Basics and How to Qualify for Enrollment

Reviewed by: Michael Howard, Licensed Insurance Agent. Written by: Andrew Hall.

Older couple laughing and eating pastries.

Key Takeaways

  • When you qualify for MedicareOriginal Medicare (Parts A and B) is fee-for-service health insurance available to all Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). and MedicaidMedicaid is a state-based health insurance program based on an individual's financial needs., 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 65 million people [1] 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?

What’s the Difference Between Medicaid and Medicare?

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.

Am I Dual-Eligible?

Dual-eligible beneficiaries can enroll in Medicare Part AMedicare Part A, also called "hospital insurance," covers the care you receive while admitted to the hospital, skilled nursing facility, or other inpatient services. Medicare Part A is one of the pain parts of Original Medicare., Medicare Part BMedicare Part B is the portion of Medicare that covers your medical expenses. Sometimes called "medical insurance," Part B helps pay for the Medicare-approved services you receive., 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.

When Do I Enroll?

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.

How Does Payment Work?

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.

How Do I Enroll?

The first thing you need to do is find out if you are eligibleSome health plans require you to meet minimum requirements before you can enroll. The rules of eligibility can vary by plan.. You must be a resident of the state where you apply for the Medicaid program. Visit your state Medicaid site [2] for information on eligibility, coverage, and more. You can apply with your state Medicaid agency in person, over the phone, or online. A GoHealth licensed insurance agent can also help you through the process.

FAQs

Does Medicaid cover mental health, dental, nursing homes, or long-term care?

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.

Who can tell me if I am eligible for Medicaid?

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.

 

How are Medicare and Medicaid Different for Nursing Home Coverage?

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 co-payment of $170.50 per day.  However, if you have a Medigap policy, then that copayment will be covered.

What's Next?