There are a variety of Medicare Advantage plans for people with Medicare & Medicaid. Learn about these plans and how Medicare and Medicaid can work together.
Medicaid helps pay for health care services for people who have limited financial resources.
Medicare is a federally-run health insurance program for Americans age 65 and older and some younger people with a qualifying disability.
Depending on where you live, your financial resources and other factors, you may be eligible for Medicare, Medicaid or both. You may also be eligible for a Medicare Dual Eligible Special Needs Plan (D-SNP) — a type of Medicare Advantage plan — if any are available where you live.
Learn more about Medicare and Medicaid – including how they are different as well as how they can work together – so that you can find the coverage that best fits your needs.
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TTY 711, 24/7 Continue onlineIt’s important to understand some of the differences between Medicare vs. Medicaid, and also how the two programs work together.
Two primary differences between Medicare and Medicaid are:
For beneficiaries who qualify for both programs, Medicare always acts as the primary payer for medical services, while Medicaid serves as the secondary payer.
That means Medicare is the first to pay for covered services and items, and then Medicaid pays for any remaining qualified costs.
There are several different ways that Medicaid and Medicare can work together.
You can compare Part D plans available where you live, learn about their Medicare plan ratings and Medicare Part D Low Income Subsidy (LIS, also called Extra Help) program.
If you are a member of a Medicare Savings Program (more information below), you also automatically qualify for Medicare Extra Help.
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TTY 711, 24/7There are several types of Medicare Savings Programs (MSPs) that are run by Medicaid.
The QMB program helps pay your Medicare Part A and Part B premiums, deductibles, coinsurance and copayments.
In order to be eligible, you must meet both of the following criteria:
The SLMB program helps pay for Medicare Part B premiums.
Eligibility requires meeting both of the following:
The QI program is another way to receive help paying for the Medicare Part B premium.
To be eligible, you must satisfy both of the following requirements:
The QDWI program is for people who:
The program helps pay for the Medicare Part A premium.
The QDWI program is for individuals with a monthly income or no more than $4,249 per month or resources of less than $4,000 in 2024. Married couples may qualify if they have an income of less than $5,722 per month or resources of less than $6,000.
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TTY 711, 24/7A Dual Eligible Special Needs Plan, or D-SNP, is a certain type of Medicare Advantage (Medicare Part C) plan.
A D-SNP is specifically designed to meet the needs of someone with an income that qualifies them for Medicaid. This includes basic care like doctor’s visits and prescription drugs.
Some plans may include extra benefits that Original Medicare and Medicaid don’t cover.
“Dual eligible” means being eligible for both Medicare and Medicaid at the same time.
Medicare eligibility requires meeting each of the following:
Medicaid eligibility requirements can differ from one state to the next. But generally speaking, lower income individuals, couples, children and pregnant women are typically eligible.
Contact your state’s Medicaid program to find out the eligibility requirements where you live.
There are two levels of Medicaid and Medicare coverage for those who are dual eligible:
Qualifying as full dual eligible is based on assets that include checking and savings accounts, stocks, real estate (other than your primary residence) and vehicles if you own more than one.
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TTY 711, 24/7There are four parts of Medicare that each offer different types of coverage. Medicare Supplement Insurance is also a type of privately sold Medicare plan.
Many Medicare Advantage plans may also provide additional benefits like prescription drug coverage.
When looking for a Medicare or Medicaid plan that best fits your needs, you can consider the following questions to steer you in the right direction.
You can also call to speak with a licensed insurance agent to find out if a D-SNP Medicare Advantage plan is available in your area at 1-800-557-6059 TTY Users: 711 24/7.
D-SNP Medicare Advantage plans aren’t available in all areas, and the benefits offered by plans can vary. Call today to speak with a licensed insurance agent who can help you compare the Medicare and Medicaid Dual Eligibility options that are available where you live.
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TTY 711, 24/7Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
