Can You Be on Medicare and Medicaid at the Same Time
What is Medicare Dual Eligible and How Do I Authorize?
Most Americans understand that when they plow 65, Medicare volition become their primary wellness insurance plan. Withal, many Americans are less familiar with another health care program, Medicaid, and what it means if they are eligible for both Medicare and Medicaid. If you are dual eligible, Medicaid may pay for your Medicare out-of-pocket costs and certain medical services that aren't covered by Medicare.
What is Medicaid?
Similar Medicare, Medicaid is a health intendance coverage plan funded by the federal government. It was established to help low-income individuals admission health care coverage. Unlike Medicare, even so, Medicaid is partially funded by land governments. This means that states take the flexibility to blueprint their Medicaid programs to all-time meet the needs of their residents, as long as the program meets the minimum federal guidelines. As a result, Medicaid eligibility, services, and cost-sharing (the corporeality yous pay aslope your insurance) policies volition vary state-by-state, while the Medicare program is by and large consistent across all states.
How exercise I know if I qualify for Medicaid and Medicare?
Twelve million individuals are currently enrolled in both Medicaid and Medicare.one These individuals are known as "dual eligible beneficiaries" because they qualify for both programs. Every bit long every bit you see the federal qualifications for Medicare eligibility and the state-specific qualifications for Medicaid eligibility, you will authorize as a dual eligible. To authorize for Medicare, individuals generally need to be 65 or older or accept a qualifying disability.
There are several levels of assistance an individual can receive as a dual eligible casher. The term "full dual eligible" refers to individuals who are enrolled in Medicare and receive total Medicaid benefits. Individuals who receive assistance from Medicaid to pay for Medicare premiums or price sharing* are known as "partial dual eligible."
*Cost sharing is the amount of your health care that you pay out of your own pocket. Typically, this includes deductibles, coinsurance, and copayments.
Levels of Medicaid coverage
Total dual eligible coverage
Qualifications for Medicaid vary by state, but, generally, people who authorize for total dual eligible coverage are recipients of Supplemental Security Income (SSI). The SSI plan provides cash assistance to people who are anile, blind, or disabled to assist them meet bones food and housing needs. The maximum income provided by the federal government for SSI in 2022 is $783 per month for an individual and $1,175 per month for a couple.2
To qualify for SSI, y'all must be under a specified income limit. Additionally, your assets must be limited to $2,000 for an individual (or a child) and $three,000 for a couple.three Qualifying assets typically include things similar checking and savings accounts, stocks, real estate (other than your primary residence), and vehicles if you own more than one.
Partial dual eligible coverage
Individuals who are fractional dual eligible typically autumn into one of the following four Medicare Savings Programme (MSP) categories.
| Program | Eligibility | Benefits |
|---|---|---|
| Qualified Medicare Beneficiary (QMB) Program | Monthly income limit: $one,084 for an private, $ane,457 for a couple | Helps pay for Part A and/or Function B premiums, deductibles, coinsurance, and copayments |
| Specified Low-Income Medicare Beneficiary (SLMB) Program | Monthly income limit: $1,296 for an individual, $i,744 for a couple | Helps pay for Part B premiums |
| Qualifying Individual (QI) Programme | Monthly income limit: $1,456 for an individual, $1,960 for a couple | Helps pay for Role B premiums |
| Qualified Disabled Working Private (QDWI) Program | Monthly income limit: $iv,339 for an individual, $5,833 for a couple | Pays the Function A premium for certain people who take disabilities and are working |
Asset limits are determined at whatsoever signal in fourth dimension, including but non limited to time of application, eligibility conclusion, and/or eligibility redetermination.
Federal law defines income and resource standards for full Medicaid and fractional dual eligible categories, but states have the option to raise those limits above the Federal minimum standard.
Assets (resources) are different from income and tin include things like cash, bank accounts, investments, and property. 4
Your state's Medicaid eligibility office will assist you lot determine any program you are eligible for and if at that place are boosted state-specific programs available.
What does Medicare and Medicaid pay for?
Medicaid is known as the "payer of terminal resort." As a result, any health care services that a dual eligible casher receives are paid first by Medicare, and then by Medicaid. For full dual eligible beneficiaries, Medicaid volition cover the price of care of services that Medicare does not cover or only partially covers (equally long every bit the service is as well covered by Medicaid). Such services may include but are not limited to:
- Nursing home care
- Care at an intermediate intendance facility
- Long-term institutional intendance
- Home wellness services
- Personal intendance services (available in some states)
- Other home and customs-based services
- Transportation services
- Dental services (available in some states)
- Eye examinations for prescription glasses (available in some states)
The financial aid provided to partial dual eligible beneficiaries is outlined in the table above.
What are my options for receiving care as a dual eligible?
People who qualify as dual eligible accept several options for how their care is delivered, although the number of bachelor options volition vary at the state level.
Original Medicare
Some Medicare beneficiaries may choose to receive their services through the Original Medicare Program. In this case, they receive the Part A and Part B services direct through a plan administered past the federal authorities, which pays providers on a fee-for-service (FFS) basis. In this case, Medicaid would "wrap around" Medicare coverage by paying for services not covered past Medicare or by covering premium and toll-sharing payments, depending on whether the beneficiary is a full or partial dual eligible.
Medicare Reward
Medicare Advantage plans are private insurance health plans that provide all Part A and Part B services. Many as well offer prescription drug coverage and other supplemental benefits. Similar to how Medicaid works with Original Medicare, Medicaid wraps effectually the services provided past the Medicare Reward plan andserves as a payer of terminal resort.
Medicaid Managed Care
Some states deliver care to the dual eligible population through Medicaid managed care programs. Others have established Medicaid managed care plans specific to the dual eligible population. Medicaid managed care is similar to Medicare Advantage, in that states contract with individual insurance wellness plans to manage and deliver the intendance.
In some states, the Medicaid managed care plan is responsible for coordinating the Medicare and Medicaid services and payments. In other states the payments related to Medicaid and Medicare are handled at the state/federal level, and the Medicaid managed care program is only responsible for analogous Medicaid services.
Dual Eligible Special Needs Plans (D-SNP)
In some states, dual eligible beneficiaries may have the choice of enrolling in a D-SNP, which is different from a traditional SNP or Special Needs Programme. These plans are specially designed to coordinate the care of dual eligible enrollees. Some plans may too be designed to focus on a specific chronic condition, such equally chronic heart failure, diabetes, dementia, or End-Phase Renal Disease. These plans oft include access to a network of providers who specialize in treating the specified condition. They may likewise include a prescription drug benefit that is tailored to the condition.
Programs of All-inclusive Intendance for the Elderly (PACE)
Similar to D-SNPs, Footstep plans provide medical and social services to frail and elderly individuals (most of whom are dual eligible). Stride operates through a "wellness home"-type model, where an interdisciplinary team of health care physicians and other providers work together to provide coordinated care to the patient. PACE plans also focus on helping enrollees receive care in their homes or in the community, with the goal of avoiding placement in nursing homes or other long-term care institutions.
Which plan should I choose?
Programs and plans may be express depending on your state and service area. Additional programs may also be bachelor in some locations. To learn more nigh which type of plan is right for y'all, come across your state's Medicaid website for contact information.
Sources:
Content on this site has not been reviewed or endorsed by the Centers for Medicare & Medicaid Services, the United States Government, any state Medicare agency, or any individual insurance agency (collectively "Medicare System Providers"). Eligibility.com is a DBA of Clear Link Technologies, LLC and is not affiliated with any Medicare System Providers.
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Source: https://eligibility.com/medicare/programs/dual-eligible-definition-qualifications
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