Medicare & Medicaid
How two plans work together to provide complete coverage.
Medicare & Medicaid Programs
The words “Medicare” and “Medicaid” are so much alike that it’s easy to get them confused. Both are government programs and both help people pay for health care. But that’s where the similarities end.
Whereas Medicare beneficiaries typically qualify based on age, Medicaid beneficiaries qualify based on income.
When individuals have both Medicare and Medicaid, it is often referred to have having dual enrollment.
Benefits of Having Both
If you wish to have these benefits listed, you will need have this approved by CMS.
Dual plans offer extra benefits at no extra cost.
Dual plans go beyond either Medicaid or Original Medicare alone. You’ll still keep the Medicaid benefits you get today. And better yet, with a dual plan, you could get many extra benefits and features than Original Medicare at no extra cost. These extra benefits may include:
- Dental care, plus credit for restorative work.
- Eye exams, plus credit for eyewear.
- Hearing exams, plus credit for hearing devices.
- Rides to health care visits and the pharmacy.
- Credits to buy hundreds of health-related products.
As an added bonus, people who are dual eligible can usually enroll for no monthly premium.
Being Dual eligible allows individuals additional election periods, other than the Initial Election Period (IEP), Annual Election Period (AEP), and the Open Enrollment Period (OEP).
These additional election periods come in the form of being able to enroll or dis-enroll once per calendar quarter, January through September.
|What You May Have Now||What You Could Have|
|Doctor and outpatient care||✓||✓|
|More choice of doctors||✓|
|More hospital choices||✓|
|Additional prescription drug coverage||✓|
* Benefits assuming you qualify for a Dual Special Needs Plan.
It can be a good idea to review your Medicare Prescription Drug Plan coverage every year, to see if your plan covers the medications you need now and may need in the upcoming year.
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FREQUENTLY ASKED QUESTIONS
What's the difference between Medicaid and Medicare?
Medicare is a national health insurance program run by the federal government. It’s for people age 65 and older, and also some people under age 65 with certain disabilities. Medicaid is a joint program that states and the federal government fund together. Millions of people get health coverage through their state Medicaid program. Children, pregnant women, elderly adults and people with disabilities, as well as eligible low-income adults are typically covered by Medicaid.
What does dual eligible mean?
People who qualify for both Medicare and Medicaid at the same time are “dual eligible.” They are “dual eligible” for both health care programs.
Who can qualify for Medicaid?
All state Medicaid programs cover low-income people who qualify, including families and children, pregnant women, the elderly and people with disabilities. Some state Medicaid programs cover all low-income adults who earn less than a set income level.
How can I enroll in Medicaid?
To apply for Medicaid, you’ll need to submit an application to the agency that manages the Medicaid program in your state.
What do I need to apply for Medicaid?
When you apply for Medicaid, you’ll need to fill out an application form. Different states have different requirements for Medicaid. You’ll likely need to have various documents, such as:
- Information about household members (name, date of birth, and Social Security number)
- Proof of citizenship
- Financial information
Rent or mortgage information
- Expenses (utilities, daycare, etc.)
- Vehicle information
- Bank statements
- Income (pay stubs)
- Proof of disability or medical records showing a lasting medical condition
- Recent medical bills