This FAQ (Frequently Asked Questions) answers common questions about Medicaid and how it works with Medicare.
What is Medicaid?
Medicaid is a federal and state program that provides health coverage for low-income people. Medicaid is administered by the respective States. Costs to the beneficiary are usually very low compared to getting the same coverage in the market.
What is the difference between Medicare and Medicaid?
Medicare is a federal program that provides health coverage if you are 65 or older, have been disabled for two years or have ESRD or ALS, irrespective of income.
Medicaid is primarily for low-income persons to help them with healthcare coverage and costs. It is not dependent on age.
Who are dual eligibles?
Dual-eligible is a term used for people who qualify for both Medicare and Medicaid benefits.
How can one qualify for Medicaid?
You may qualify for partial or full support through Medicaid based on family size and income.
Through various programs, Medicaid usually provides health coverage for qualifying low-income people, children, pregnant women, the elderly, and those with disabilities.
Medicaid programs vary by State. Make sure you understand the support your State’s programs offer and their qualifying criteria. Some states cover all low-income adults below a certain income level.
What happens if I have Medicaid? How does it impact my Medicare?
If you have Medicaid and enroll in Medicare, Medicaid may help pay for costs and services that Medicare does not cover such as nursing facility care beyond the 100-day limit, prescription drugs, eyeglasses and hearing aids. Medicare will be the primary payer and Medicaid secondary.
If you have full Medicaid benefits, you may not need a Medicare Supplement Policy. Carriers may even be excluded from selling you a Medicare Supplement policy in this situation.
How does having Medicaid impact my enrollment periods?
Having Medicaid does not usually impact your Medicare enrollment periods. However, if you are planning to enroll in a dual-eligible Special Needs Plan (D-SNP), you can do that anytime though the frequency is now limited to once per quarter during the first three quarters of the year. Annual Election Period (AEP) rules apply during the fourth quarter.
What impact does having Medicaid have on my Medicare costs?
Medicaid programs wrap around Medicare's coverage, providing financial assistance in various forms such as Medicare premiums, deductibles, and coinsurance, as well as some benefits not covered by Medicare.
Are there any specific Medicare Plans for dual eligibles?
Medicaid coverage and the type of assistance for which a person qualifies varies by State.
It is advisable to understand what coverage you have before deciding on whether to enroll into a dual-eligible Special Needs Plan (D-SNP). Remember that a D-SNP may not be available in your zip code or service area.
What if I no longer qualify for Medicaid?
If you no longer qualify for Medicaid, you may be eligible for a Special Enrollment Period (SEP) to get desired Medicare coverage. Make sure you take advantage of this SEP while it lasts.
Click here to learn more about Medicare, its various Parts, different enrollment periods and your costs.
We have also created videos to help you better understand various topics related to Medicare. Select and watch a video explaining the topic of your interest in a simple and intuitive manner.
Remember that you cannot choose just any combination of Parts and Plans. Let Lighted Road Insurance guide you step-by-step through the Medicare ecosystem and help you in selecting the right plan(s) for your needs.
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Last Updated: 01-10-2021