Medicare and Medicaid: How to Qualify for Both


Medicare and Medicaid are different programs. Depending on your healthcare and financial situation, it’s possible to have both. But, just because you have one, doesn’t mean you’ll automatically have the other. Medicare is a federal program, while Medicaid is a state program.

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Medicare vs. Medicaid

Many confuse Medicare vs. Medicaid. But, Medicare is for those over 65 or with long-term disability. Then, Medicaid is for those with low income and few resources.

Criteria for Medicaid can differ between states. Medicaid pays the part that Medicare doesn’t cover with partial dual-eligibility. Further, Medicaid will cover your Part B premiums, and if applicable, Part A. Beneficiaries who qualify for both are dual-eligible.

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The Difference Between Medicare and Medicaid

The differences between Medicare and MedicaidAlthough the two programs share the same prefix and offer health coverage, they’re different. Nearly every American will one day qualify for Medicare, but Medicaid is only for those with a low income.

With Medicare, think “care” for those 65+ or those with disabilities. Then, Medicaid is “aid” to those with a low income. Medicaid is free. Medicare is not free. Those with Medicaid won’t be subject to the Part B premium or Part B late enrollment penalties. But, those with only Medicare will be responsible for applicable costs.

Just because Medicaid is free doesn’t mean it’s for everyone. Approval time for Medicaid can take up to 60 days. Benefits are for US citizens; but, children of illegal immigrants can qualify.

If you get Social Security supplemental benefits, you’ll qualify for Medicaid. Also, Medicaid has benefits Medicare doesn’t; this includes vision, dental, and long-term custodial care.

How to Qualify for Medicare and Medicaid?

Beneficiaries can enroll in Medicaid through the state program office. If you think you’re eligible, contact your state health department to apply. To be eligible for Medicaid your income will need to be below a predetermined amount.

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If your income is above this amount but you struggle with high medical costs, you may want to check if a Medicaid spend-down program is available in your state.

You’re eligible for Medicare if you’re over the age of 65 or on disability for at least 24 months. Although, you apply for Medicare online at the Social Security Administration website.

Can I Have Both Medicaid and Medicare?

You can collect both; this is dual-eligibility. Medicare will pay out before Medicaid. Your Medicaid will act like Medigap.

To Qualify for Dual-Eligibility:

  • Meet the income requirements in your state for Medicaid
  • Eligible for Medicare due to aging in or disability

Do I Need Medicare Part B if I Have Medicaid?

Only if you’re eligible for Medicare, you’ll need Part B alongside your Medicaid. For those that aren’t Medicare eligible, you won’t need Part B.

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If I Have Medicaid, Do I Need Medicare Part D?

Those that have Medicare and Medicaid will automatically be enrolled in a Part D plan if they don’t select one for themselves. It’s in the enrollees’ best interest to select a policy to enroll in, instead of being dropped into a plan. But, either way, Medicaid will help cover the costs associated with premiums, copayments, or coinsurances.

What is FBDE for Medicare and Medicaid?

Full-Benefit Dual-Eligible (FBDE) individuals are eligible for Medicare as well as full Medicaid benefits through their state. This entitles them to coverage of the following through Medicare Savings Programs: Part A and B premiums, deductibles, coinsurance, and copays.

Is There a Special Enrollment Period for Medicare Dual-Eligible?

Those with Medicaid and Medicare qualify for a Special Enrollment Period; you can disenroll, join, or switch plans. The Special Enrollment Period begins the month a person is eligible for assistance. The new plan becomes valid on the first day of the month after enrolling.

Are There Medicare and Medicaid Special Needs Plans?

Medicare Advantage Special Needs Plan could help cover costs. The plan may cover routine dental, vision, and hearing. Some plans even include a gym membership such as Silver Sneakers.

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Do You Get Guaranteed Issue Rights for Loss of Medicaid Coverage?

In some states, you’re granted guaranteed issue rights if you lose your Medicaid coverage. 

FAQs

Can you qualify for both Medicare and Medicaid?
You can qualify for both Medicaid and Medicare. If you’re eligible for both, most of your health care costs will have coverage. Anyone eligible for both at the same time is dual-eligible. Further, Nearly 20% of Medicare recipients can get full Medicaid.
Who qualifies for both Medicare and Medicaid?
To qualify for both, you must meet federal requirements for Medicare. Then, you’ll have to meet the state-specific requirements for Medicaid.
How to apply for Medicare and Medicaid?
You might wonder how to apply for Medicare and Medicaid. The application for these health programs is simple! Apply for Medicare either online or over the phone. Then, the Medicaid application can be made in person or online.
How often can dual-eligible beneficiaries change plans?
If you have Medicare & Medicaid, you can change your plan at any time. The effective date of the policy will be the 1st day of the following month.
How often can dual-eligible change plans?
Dual-eligible recipients can change plans at any point during the year. The effective date of your health plan starts the first day of the next month.
If a patient has Medicare and Medicaid, which is primary?
When using both, Medicare is the primary payer. Services will first get coverage from Medicare. Anything that Medicare doesn’t cover, Medicaid will pick up.

Get Help Finding a Medicare and Medicaid Policy

Medicaid and Medicare are not that similar. Medicaid is available to individuals and families living below the poverty level. But, Medicare is for people 65 and older, as well as those on disability.

Once you have clarity on the facts regarding Medicare vs. Medicaid, you can make the right decisions. If you have questions about your Medicare options, contact us today.

Our agents can inform you of all your options. Call us at the number above and we can help you review your best options. Or, fill out an online rate form to see your rates now.

Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

4 thoughts on “Medicare and Medicaid: How to Qualify for Both

  1. I’ve got Medicare but I don’t have a supplement!!! I was in the Hospital 2 weeks ago with a bladder Infection!!! I’m scared I can’t pay what they say I’ll owe!!!!

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