Dear Marci,
I have Medicare, and I sometimes find it difficult to afford the costs of my health care. One of my friends suggested that I apply for Medicaid. What is Medicaid, and how does it work with Medicare?
-Jeanne (Manchester, NH)
Dear Jeanne,
Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets. Each state tuns various Medicaid-funded programs for different groups of people, including older adults, people with disabilities, children, pregnant people, and parents and/or caretakers of children. All states have Medicaid programs for people with limited income and assets who need nursing home care, long-term care services, and home health care services. Some states also have programs for individual adults who do not fit any of these categories.
If you are eligible for both Medicare and Medicaid (dually eligible), you can enroll in both. If you qualify for a Medicaid program, it may help pay for costs and services that Medicare does not cover. Here are a few examples of how Medicaid can work with Medicare:
- Medicaid can provide secondary insurance: For services covered by Medicare and Medicaid (such as doctors’ visits, hospital care, home health care, and skilled nursing facility care), Medicare is the primary payer. Medicaid is the payer of last resort, meaning it always pays last. When you visit a provider or facility that takes both forms of insurance, Medicare will pay first and Medicaid may cover your Medicare cost-sharing, including coinsurance charges and copays.
- Medicaid can provide premium assistance: In many cases, if you have Medicare and Medicaid, you will automatically be enrolled in a Medicare Savings Program (MSP). In other cases, you can apply for an MSP even if you are not automatically enrolled. MSPs pay your Medicare Part B premium and may offer additional assistance.
- Medicaid can provide additional cost-sharing assistance: Depending on your income, you may also qualify for the Qualified Medicare Beneficiary (QMB) MSP. If you are enrolled in QMB, you do not pay Medicare cost-sharing, which includes deductibles, coinsurances, and copays, when you see a provider who accepts Medicare.
- If you are eligible for Medicaid, you are eligible for prescription drug assistance: Dually eligible individuals are automatically enrolled in the Extra Help program to help with their prescription drug costs.
- Medicaid can offer care coordination: Some states require certain Medicaid beneficiaries to enroll in Medicaid private health plans, also known as Medicaid Managed Care (MMC) plans. These plans may offer optional enrollment into a Medicare Advantage Plan designed to better coordinate Medicare and Medicaid benefits. Note: You cannot be required to enroll in a Medicare Advantage Plan.
Make sure to call 1-800-MEDICARE or contact your local Medicaid office to learn more about Medicare and Medicaid costs and coverage, especially if you are dually eligible.
-Marci