The government-funded healthcare programs Medicare and Medicaid are two distinct programs; however, a person may be eligible for both at the same time.
Medicare and Medicaid are both government-sponsored programs that are 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 to be dual-eligible for Medicare and Medicaid benefits.
In this post, we’ll go through Medicare and Medicaid eligibility, as well as what you should know about each program.
Who are the dual-eligible recipients?
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 gaps that exist 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.
There are a few main distinctions between Medicare and Medicaid.
Medicaid is a health insurance program that provides financial assistance to individuals and families who are low-income or have limited financial resources.
While individual states are responsible for running the Medicaid program, it is the federal government that 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 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 the history of their own or their spouse’s job. 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 any income-related criteria.
The Medicare eligibility requirement is that you must be 65 years old or older. If you or your spouse are 65 years old or older and have paid enough Medicare taxes through previous employment, 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 various other medical expenses.
Some people under 65 may be eligible for Medicare, such as those who have:
- 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 of time 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 the amount of money that someone who is only eligible for Medicare receives.
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, is used to determine a person’s eligibility for a variety of government benefits.
In addition to the 48 contiguous states and the District of Columbia, the FPL also applies to Alaska and Hawaii, with Alaska and Hawaii having a higher FPL. The number of people in a family and changes over time determines the FPL.
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
The benefits available to those who qualify for both Medicare and Medicaid coverage may include all of the benefits available to partial-dual enrollees in addition to additional 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, that are available to them.
Variations in geography
Medicaid benefits and coverage vary from one state to the next, 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.
To learn more about Extra Help and how to apply for it, go to the Medicare website.
A person’s health and income level may qualify them for both Medicare and Medicaid.
Meanwhile, Medicare will generally cover healthcare costs initially, and Medicaid assists with out-of-pocket and non-covered expenses.
Medicaid eligibility varies by state, as well as the income level restrictions.