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How to qualify for both Medicare and Medicaid?

qualify for both Medicare and Medicaid

The government-funded healthcare programs Medicare and Medicaid are two distinct programs; however, a person may qualify for both Medicare and Medicaid at the same time.

Medicare and Medicaid are government-sponsored programs intended to assist people in meeting their healthcare expenses. A person who qualifies for both programs is called “dual eligible” by the federal government.

According to Medicaid.gov, approximately 12 million people in the United States are considered dual-eligible for Medicare and Medicaid benefits.

This post will go through Medicare and Medicaid eligibility and what you should know about each program.

Who can qualify for both Medicare and Medicaid?

People who are dual-eligible for Medicare and Medicaid are referred to as dual-eligible beneficiaries. Moreover, each state determines Medicaid coverage, and as a result, Medicaid benefits may differ.

Receiving both Medicare and Medicaid can assist in lowering healthcare expenditures for individuals who are in need.

According to general practice, Medicare pays for healthcare services first, with Medicaid covering any existing gaps up to Medicaid’s payment flexibility limits.

According to an article in the journal “Health Affairs,” an estimated two-thirds of those who are dual-eligible meet the standards for Medicare based on age. The remaining one-third of dual-eligible people meet the criteria due to a disability.

Medicare vs Medicaid: What’s the Difference?

There are a few main distinctions between Medicare and Medicaid.

Medicaid

Medicaid is a health insurance program that provides financial assistance to low-income individuals or families or families with limited financial resources.

While individual states are responsible for running the Medicaid program, the federal government creates the rules and regulations that govern it.

Medicaid is available to people of all ages and gender identities. Children, families, pregnant women, persons with disabilities, and the elderly may all be eligible for Medicaid coverage under certain conditions.

Medicare

Medicare is a health insurance program that provides coverage to people 65 and older and those with certain medical conditions, including those who have any disability.

A person must meet eligibility standards based on their own or their spouse’s job history. They may be eligible for free hospitalization but must pay a premium for medical and prescription drug coverage.

To be eligible for Medicare, a person does not need to meet income-related criteria.

Medicare Ineligibility

The Medicare eligibility requirement is that you must be 65 years old or older. Suppose you or your spouse are 65 years old or older and have paid enough Medicare taxes through previous employment. In that case, you or your spouse may be eligible for premium-free Part A of the Medicare program (hospital coverage).

They may also be eligible for Medicare Part B, covering doctor visits and other medical expenses.

Some people under 65 may be eligible for Medicare, such as those who have:

  • Disabilities
  • Renal failure toward the end of life
  • Amyotrophic lateral sclerosis (ALS) is a type of amyotrophic lateral sclerosis.

Some people, such as those with impairments, may have to wait a certain amount before being eligible for Medicare.

Dual-eligible people frequently suffer from chronic illnesses and functional impairments that necessitate more extensive medical treatment.

Someone eligible for Medicare and Medicaid receives twice as much money as someone only eligible for Medicare receives.

Medicaid Ineligibility

Medicaid eligibility varies depending on where a person resides, as various states have different qualifications.

Every year, Medicaid rules may change.

The Federal Poverty Level (FPL), which the Department of Health and Human Services (HHS) determines every year, determines a person’s eligibility for various government benefits.

In addition to the 48 contiguous states and the District of Columbia, the FPL applies to Alaska and Hawaii, with Alaska and Hawaii having a higher FPL. The number of family members and changes over time determine the FPL.

Dual eligibility: Qualify for both Medicare and Medicaid

A person must qualify for either partial-dual or full-dual coverage to be eligible for both Medicare and Medicaid.

The amount of Medicaid assistance a person receives determines their eligibility for partial-dual coverage. The following are some examples of various coverage:

  • The premium for Part A (if applicable)
  • The premium for Part B
  • Coinsurances
  • Copayments
  • Deductibles

The benefits available to those who qualify for both Medicare and Medicaid coverage may include all of the benefits available to partial-dual enrollees and other benefits such as long-term care services for those who qualify for both.

Depending on a person’s Federal Poverty Level (FPL), Medicaid provides various programs, such as prescriptive drug assistance programs, available to them.

Variations in geography

Medicaid benefits and coverage vary from state to state, and there are differences between them. Depending on the state, Medicaid coverage may be available to those who earn more than the standard income limits.

The Medicaid website can assist a person in determining which services are available to them in their area based on their geographic location.

Medicare Part D Extra Assistance Program

Aside from Medicaid, many other programs assist with medical expenses, and government sponsors them. Extra Help, a program that assists Medicare Part D enrollees with their prescription drug costs, can be applied for by a qualified individual.

To be eligible for Extra Help, a person’s combined investments, real estate property, and savings must total no more than $29,160 if they are married and live with their spouse or $14,610 if they are single.

Go to the Medicare official website to learn more about Extra Help and how to apply for it.

Summary

A person’s health and income level may qualify them for Medicare and Medicaid.

Meanwhile, Medicare generally covers healthcare costs initially, and Medicaid assists with out-of-pocket and non-covered expenses.

Medicaid eligibility varies by state, as well as income level restrictions.

You can also visit our website NewMedicare.com for more assistance.

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