Who Is Eligible for Both Medicare and Medicaid?

Qualifying for Medicare hardly means free health care – there are still premiums and deductibles.

Can You Have Medicaid and Medicare?

Yes; people who qualify for Medicare as well as Medicaid receive help paying their out-of-pocket costs. These individuals have so-called “dual eligibility.”

What’s the Difference Between Medicare and Medicaid?

Medicare and Medicaid are both government-run programs that provide health coverage. However, they are in most every other way quite different from one another.

Medicare is a federal health care program available to anyone 65 or older who receives Social Security retirement benefits. (Medicare also helps many individuals with disabilities.)

In place since 1965, the Medicare program consists of four main parts, each of which has premiums and co-pays associated with them:

• Part A covers hospital stays and some limited nursing home stays
• Part B covers office visits, physician fees, medical equipment, home care, and preventative services
• Part C (called Medicare Advantage) permits Medicare enrollees to receive Part A and B benefits through private insurance companies
• Part D covers prescription medications

Costs for each of these parts of the program typically shift annually.

Meanwhile, Medicaid provides health insurance to low-income adults, children, as well as people with disabilities. You must meet strict income and asset limits to qualify for Medicaid coverage. Because it is a joint federal and state program, the program’s rules can vary across states. Note that certain states also may use different names for Medicaid, such as “Medi-Cal” in California.

Today, Medicaid also serves as the primary method of paying for nursing home care for most of the nation's middle class.

As mentioned above, if you qualify for both Medicare and Medicaid, you are dually eligible.

How to Qualify for Both Medicare and Medicaid

To be dually eligible, you must be:

• Enrolled in Medicare as well as full Medicaid; or
• Enrolled in a Medicare Savings Program.

What Are Medicare Savings Programs?

Medicare Savings Programs (MSPs) are state programs, run through Medicaid, which provide individuals with help paying for Medicare premiums. When a person’s Medicare and Medicaid coverage overlap, Medicare will always pay for the services first. If Medicare does not cover the full cost, then Medicaid may then cover the remaining cost.

Medicaid may also cover some costs that Medicare typically does not, such as long-term nursing home care, hearing aids, or most dental care.

What Benefits Are Available to People With Dual Eligibility?

Benefits for those who are dually eligible depend on the Medicaid program in which the individual has enrolled. That is, a person might have enrolled in full Medicaid or one of four main types of MSPs:

• Full Medicaid. Qualifying individuals receive full Medicaid coverage. Because each state administers its own Medicaid program, additional benefits can vary based on where you live.
  
  For example, some states may pay for your Medicare Part B premiums. In addition, beneficiaries do not have to pay more than the amount allowed under the state’s Medicaid program for services by Medicare providers.

• Qualified Medicare Beneficiary (QMB) Program. Those who qualify for QMB benefits receive help paying for Medicare Part A and Part B premiums. They also get support covering deductibles, co-insurance, and co-payments.
   
• Specified Low-Income Medicare Beneficiary (SLMB) Program. SLMB enrollees receive help paying Part B premiums only.
   
• Qualifying Individual (QI) Program. People who enroll in the QI Program receive assistance covering the costs of Medicare Part B premiums. However, support through this program is available only on a first-come, first-served basis.
   
• Qualified Disabled Working Individual (QDWI) Program. The QDWI Program pays Medicare Part A premiums for certain disabled and working enrollees under 65 years old. Individuals must meet specific income and resource limits set by their state.

Consult With an Elder Law Attorney

Medicaid and Medicare rules can prove quite complicated, and often vary according to the state in which you reside. Work with an expert if you have questions about qualifying for these programs or want to understand your rights. Find an experienced elder law attorney near you today.

Additional resources available for free may prove helpful in accessing information about Medicaid and Medicare benefits:

• The Centers for Medicare and Medicaid Services (CMS) features a fact sheet on the basics of the two programs.
• The Medicare Rights Center is an excellent resource, offering articles and webinars for free about various aspects of Medicare.

In addition, check out the following four articles to learn more about Medicaid and Medicare basics:

• How Gifts Can Affect Medicaid Eligibility
• Turning 65? What You Need to Know About Signing Up for Medicare
• How Much Money You Can Have and Still Qualify for Medicaid