Medicaid Medicare Your Coverage Options

Four things to know if your income is low and you have Medicare

Written by Diane Archer

Today, more than 11.4 million older adults and people with disabilities are enrolled in both Medicare and Medicaid.  Almost three out of four of them (72 percent) are eligible for full Medicaid benefits, the remaining 28 percent are enrolled in a Medicare Savings Program. While Medicare is an earned health care benefit for people over 65 and with disabilities, Medicaid is a means-based benefit for people with limited incomes and savings. Medicare and Medicaid work together to provide a more comprehensive set of benefits for people with low incomes.

  1. Medicaid picks up many health care costs that Medicare does not cover: Depending upon your income and assets, along with which state you live in, you might qualify for full Medicaid benefits in addition to Medicare. Medicaid would be your secondary insurance, paying after Medicare.  It generally covers the gaps in Medicare, including the Part B premium, the Part D drug premium, deductibles and coinsurance. It sometimes covers routine dental care and travel to and from the doctor’s office and some long-term care. No matter where you live, if you meet state-specific criteria, you will have coverage for nursing home care.  Depending which state you live in,, and your care needs, you might also be eligible for home or community-based care.  In addition, there are several Medicaid/Medicare demonstration projects underway testing new ways to deliver home care for people with Medicare, in one project with the help of therapists, nurses and handymen. Click here to learn more.
  2. Your state Medicaid office or SHIP program can help you know whether you qualify for full Medicaid or other low-income assistance.  Even if your income or assets are over the limit, many states have what are called “spend-down” programs that allow you to qualify for Medicaid after you have spent some of your own money for health care.  You should know that if you own a home, Medicaid does not count it as an asset. To contact your state Medicaid office, click here and to learn about free and low-cost resources, including the State Health Insurance Programs (SHIP), click here.
  3. Medicaid might require you to switch out of traditional Medicare: Some states may require you to enroll in a private health plan that covers people with Medicare, such as an HMO, if you sign up for Medicaid. You would need to give up traditional Medicare coverage, which would limit your choice of doctors and hospitals to that plan’s network of doctors and hospitals. Contact your state Medicaid office to learn about options in your state.
  4. Even if your income or assets are too high to qualify for full Medicaid benefits, Medicare Savings Programs, (administered by state Medicaid programs), may cover some of the gaps in Medicare. In 2013, 8.8 million people were enrolled in a Medicare Savings Program. Four different Medicare Savings Programs fill different Medicare coverage gaps, depending upon your income and assets. To learn more about these programs and which health care costs they pick up, click here.

In addition to Medicaid and Medicare Savings Programs, there are thousands of government and charitable programs that provide free and low-cost services across the country.

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