Can You Have Medicare and Medicaid at the Same Time?

Can You Have Medicare and Medicaid – Overview

A person can have both Medicaid and Medicare, provided they fulfill specific eligibility requirements. Some people qualify for Medicare based on their age (over 65) or if they have a disability. The same person may also be eligible for Medicaid if they meet the state’s specific eligibility requirements.

A person with Medicaid and Medicare is usually called “dual eligible” and has access to both programs’ benefits.

Dual Health Insurance Plans

Dual health plans, also known as Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs), are designed to offer combined benefits to individuals who qualify for both Medicare and Medicaid.

Dual health plans combine hospital, medical and prescription medicine coverage. As a result, dual-eligible persons can keep all their Medicaid benefits and enjoy additional benefits than the Original Medicare coverage. The best part is that such persons can get the combined benefits of Medicare and Medicaid with US$ 0 premium plans.

Can You Have Medicare and Medicaid – Dual Health Insurance Plans

Dual health insurance plans are often called “dual special needs” plans. Private health insurance companies usually offer them, so you can find a plan that suits your health and medical insurance needs. Lastly, it is essential to remember that being on a dual health plan does not affect your Medicaid benefits or eligibility.

Now that you know about dual health plans and that many people are eligible for the combined benefits of Medicare and Medicaid, let’s look at the specific benefits such individuals enjoy.

What Is Medicare and Its Benefits

Medicare is a federal health insurance program for people 65 and older, people under 65 with specific disabilities, and people of any age with End-Stage Renal Disease (ESRD). It supports seniors and their families who need financial assistance to meet their medical and health needs.

People under 65 are eligible for Medicare if they have received Social Security Disability Insurance (SSDI) for a certain period, usually 24 months, or have ESRD or ALS (Amyotrophic Lateral Sclerosis). Such cases are typically evaluated based on eligibility requirements and the details of individual insurance programs. In addition, people suffering from end-stage renal (kidney) disease are also eligible to receive Medicare benefits.

Medicare benefits are usually provided through two plans – Original Medicare and Medicare Advantage.

Original Medicare is a government-sponsored medical insurance program many senior Americans use as their primary health insurance. Under this, Medicare Part A covers inpatient hospital services, such as hospital visits, hospice care, (limited) nursing facility care, and at-home health care. Medicare Part B covers outpatient medical services, such as preventive, diagnostic, and treatment services for numerous health conditions.

Medicare Advantage (Part C) plans are offered by private companies approved by Medicare to provide all Medicare Part A and B benefits. They often include additional benefits not covered by Original Medicare, such as dental, vision, and hearing. Medicare Advantage plans can be bought from private insurance companies.

While many Medicare Advantage plans offer additional benefits like prescription drugs, dental, vision, and hearing care, coverage varies by plan, and not all plans may offer these benefits.

In short, Medicare health insurance is divided into the following types of plans:

Medicare Part A covers most inpatient medical care, including hospital stays, hospice services, some healthcare, and limited skilled nursing services.

Medicare Part B covers outpatient medical services, such as outpatient hospital care, preventive care, physician appointments, and specific medical equipment.

Medicare Part C, also called Medicare Advantage, covers and combines the benefits of Medicare Part A and B, including additional services such as dental, vision, and hearing care costs and prescription drug coverage.

Medicare Part D—According to federal guidelines, Medicare Part D offers prescription drug coverage to anyone with Medicare through Medicare-approved private insurers.

What is Medicaid and Its Benefits

Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. It offers benefits not typically covered by Medicare, such as nursing home care and personal care services. This public health insurance program aims to assist low-income families in accessing affordable healthcare services.

Medicaid coverage may include the cost of significant hospitalizations, treatments, and routine medical care. Medicaid currently serves millions of adults, children, and people with disabilities every year.

In short, Medicaid benefits include coverage for the cost of the following:

Lab and x-ray services.
Family planning services (birth control, midwives services, etc.)
Inpatient and outpatient hospital services.
Nursing facility services for individuals aged 21 or older.
Health screenings and applicable medical treatments for children.
Some states provide Medicaid coverage for adult dental services, but coverage varies by state.

As Medicaid differs in each state, we recommend you contact a caseworker to evaluate your situation and help you apply for Medicaid health insurance coverage.

Conclusion

Dual health plans are beneficial to seniors and those suffering from disabilities. The combination of Medicare and Medicaid benefits helps cover almost all healthcare aspects seniors and the disabled may need.

You can check the official website if you want additional information on this.

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