While the two may appear similar as they are both government-sponsored healthcare programs, they are actually quite different considering the benefits each plan offers and who can qualify. Medicare offers health insurance plans meant for those who are 65 and older and is not based on any type of income. On the other hand, Medicaid is more of an assistive program that offers health insurance to those with a low-income and is offered to all ages. It is possible to have both Medicare and Medicaid at the same time, which is known as dual-eligibility.
What is dual-eligibility?
Being a dual-eligible beneficiary means that you are receiving benefits from Medicaid while having Medicare as your main source of coverage. You can think of this as being similar to Medicare Supplement Plans. Let’s say that you’re enrolled in Original Medicare and have a supplement plan as well. Depending on the benefits offered by that specific supplement plan, it can cover most of the expenses that are not originally covered by Medicare or cover the remaining expenses of what Medicare didn’t pay. This is the same concept with Medicaid. Since both Medicare and Medicaid cover close to the same amount of services, Medicare will pay first for those services and then Medicaid will cover the remaining costs.
There are two different categories for dual-eligibility: full-benefit dual-eligibles and partial duals. Full-benefit dual-eligibility means that while you do have Medicare, you are also receiving benefits under Medicaid. This means that Medicare will still be your main source of coverage, but Medicaid will help cover copays and other costs such as your premium payment for Medicare.
Partial duals means that Medicaid will not pay all of the expenses, meaning you’ll only receive assistance in covering what could be your cost-sharing for Medicare-covered services.
What you need to know
While Medicaid can aid in paying certain costs not covered by Medicare, it’s important to understand that each program has its own key components that determine whether you’re eligible or not.
Eligibility for Medicare is not dependent on income. It’s dependent on age. If you are a U.S. citizen or have legal permanent residency, you WILL qualify for Medicare when you turn 65. However, there is an exception for those younger than 65 if they have disabilities or certain diseases, such as End-Stage Renal Disease. Medicaid is dependent on income and is eligible for those whose income falls below the poverty line.
Medicare is also not free, unlike Medicaid. Medicaid is a program for people with incomes up to 200% of the federal poverty level. If you qualify for Medicaid, you will not have to pay for it. Income limits are established by each state, benefits can range from payment of Medicare Part B premiums, copays and deductibles, to only providing extra help for Part D prescription drugs.
For Medicare, usually a higher premium will need to be paid if you have a higher income, but keep in mind that your ability to enroll or be eligible for will not be impacted by your income. If you have worked 10 years or more, you most likely will not have to pay a premium for Medicare Part A. However, you’ll typically have out-of-pocket costs like deductibles and other premium payments for other parts of Medicare.
While Medicare is strictly a federal program, meaning that every state offers the same basic benefits, Medicaid is both a federal and state program. This means the government will set the guidelines for Medicaid, but each state will have its own requirements to determine eligibility.
As for dependents, Medicare will not cover other dependents. Eligibility is based on each individual meeting the requirements. Medicaid will provide coverage for children up to their 19th birthday if the beneficiary meets the eligibility requirements.
Is Medicare and Medicaid right for you?
Reach out to us and book a free consultation today so we can help you determine if Medicare or Medicaid, if not both, are the best fit for you! Our experienced insurance agents work for you, not the insurance company, so give us a call today at 877-877-5505.