Today, 12.3 million older adults and people with disabilities are enrolled in both Medicare and Medicaid. Almost three out of four of them (71.1 percent) are eligible for full Medicaid benefits, the remaining 28.9 percent are enrolled in a Medicare Savings Program. While Medicare is an earned health care benefit for people over 65 and people 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.
- 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.
- 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. If you own a home, Medicaid does not count your home 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.
- Some states enroll people with Medicaid and Medicare in commercial managed care plans: These Medicare Advantage plans might create obstacles to care through limited networks and inappropriate delays and denials of care. But, no matter what state you live in, you should have the right to disenroll and switch to traditional Medicare if you’d like. If you have both Medicare and Medicaid, your out-of-pocket costs in traditional Medicare should be very little or nothing. Contact your state Medicaid office to learn about options in your state.
- 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. Four different Medicare Savings Programs fill different Medicare coverage gaps, depending upon your income and assets. For example, in 2023, the Qualified Medicare Beneficiary Program, QMB, picks up the cost of Part A premiums; Part B premiums, deductibles, coinsurance, and copayments. To qualify, your individual monthly income cannot exceed $1,235 (married $1,663) and assets $9,090 (married $13,630) plus $1,5oo for burial funds. 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.
Here’s more from Just Care:
- 8.3 million people benefit from both Medicare and full Medicaid benefits
- Medicare Advantage: Disenroll between January 1 and February 14
- Six tips for keeping your drug costs down
- PACE helps older adults stay in their communities
- To save money on your care, consider using a free charitable health clinic
- Programs that lower your costs if you have Medicare
Leave a Reply