Exploring Medicare And Medicaid Coverage
Many seniors are not aware that Medicare and Medicaid can work with each other to help lower health care costs. This is especially important since Medicaid covers different types of long-term care services that Medicare alone does not. For assistance exploring all health insurance options and methods for reducing health care costs, contact your local Area Agency on Aging . Each AAA offers free counseling through the State Health Insurance and Assistance Program to help seniors understand Medicare and Medicaid benefits.
Can I Have A Medicare Advantage Plan With Medicaid
In a growing number of counties, there are Medicare Advantage plans specifically designed for by private insurance companies for Medicare beneficiaries who also qualify for Medicaid. They are called Medicare Advantage Special Needs Plans, or just SNP for short. These unique plans take into account the special needs of low-income seniors in the region they serve and do not have the same cost-sharing requirements as normal Medicare Advantage plansMedicare Advantage , also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare …..
Some smaller, rural counties may not have SNP plans but will have a local Medicaid plan. You will need to call your local Medicaid office to learn more. Typically Medicaid coverage offers many more benefits than Original Medicare alone.
How Do You Qualify For Medicaid
You qualify for Medicaid based on your finances. Medicaid needs to see difficulties with one of two things:
What are the income requirements?
Medicaid is primarily a state-run program. Each state runs its own Medicaid program the way it sees fit. They also set local financial standards to receive Medicaid benefits.
Thats why you may qualify for Medicaid benefits when you apply, but your friend with similar income and assets who lives in a different state doesnt. It all depends on where you live.
Medicaid has two funding sources: the state and the federal government. Therefore, the money to operate Medicaid is split between the federal governments contribution and the taxes a state collects.
Keep in mind that annual income limits for Medicaid are indexed to the federal poverty level. In 2021, the limit in the continental U.S. was $12,880 for an individual and $17,420 for a couple.
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How Are My Health Care Costs Reimbursed If I Have Medicare And Medicaid
When dual eligible beneficiaries have healthcare expenses, Medicare pays first and Medicaid pays last. But this is not the case for things Medicare doesnt cover, like long-term care. If Medicaid is covering a beneficiarys long-term care, Medicare will still be the primary payer for any Medicare-covered services like skilled nursing care or physical therapy.
Although it is less common, if a dual eligible individual has additional coverage then Medicare pays first, Medigap will pay second, and Medicaid is the last payer for their claims .
What Does Medicare And Medicaid Pay For
Medicaid is known as the payer of last resort. As a result, any health care services that a dual eligible beneficiary receives are paid first by Medicare, and then by Medicaid. For full dual eligible beneficiaries, Medicaid will cover the cost of care of services that Medicare does not cover or only partially covers . Such services may include but are not limited to:
- Nursing home care
- Dental services
- Eye examinations for prescription glasses
The financial assistance provided to partial dual eligible beneficiaries is outlined in the table above.
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Qualified Disabled And Working Individual
You may be eligible to purchase Medicare Part A benefits, but unable to afford it because of your low income. In this case, Medicaid will pay your Medicare Part A premium. This is more common with people under the age of 65.
In 2021, the maximum monthly income to qualify is $4,379 for an individual and $5,892 for a couple. The 2021 maximum asset level, however, is set at just $4,000 for an individual and $6,000 for a couple.
Dual Special Needs Insurance
Even better, some insurance companies offer Medicare insurance packages specifically designed to work with your Medicaid dual-eligible status.
How so? If you have certain chronic health conditions , you may be better served by one of the dual special needs Medicare insurance plans that have extra benefits to address those specific conditions.
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What Is The Difference Between Medicare And Medicaid
If youve ever been confused about the differences between Medicare and Medicaid, you are not alone. Simply put, both Medicare and Medicaid are government-regulated health insurance programs that help to provide healthcare service and treatment to millions of Americans, but each program has slightly different rules of eligibility and provides different coverage to different groups of people.
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Medicare Advantage And Medicaid
You may be able to enroll in a Medicare Advantage plan when youre on Medicaid. For example, theres a type of Medicare Advantage plan called a Special Needs Plan, or SNP.
Special Needs Plans are geared for people in specific situations. One type of SNP is specifically for dual eligibles people eligible for both Medicare and Medicaid. Please note:
- Medicare SNPs cover the same services and supplies that all Medicare Advantage plans are required to cover.
- Make sure your doctor accepts Medicaid to make sure youre covered. Of course, the doctor must also accept Medicare assignment. Your Medicare Advantage plan should be able to help you find doctors who accept both.
- You need to be enrolled in both Medicare Part A and Part B to qualify for a Medicare Advantage plan. You must also live within the plans service area.
- With any kind of Medicare Advantage plan, in most cases you must continue paying your Medicare Part B premium. However, the Medicaid program might pay your premium.
Qualified Disabled Working Individual Program
The QDWI Program helps pay for the Medicare Part A premium for certain people who meet one of the following criteria:
- Have a disability but are still working
- Lost their premium-free Part A coverage when they returned to work
- Are not receiving medical assistance from their state
- Meet the income and resource limits below
- Income of no more than $4,379 per month for an individual in 2021, or $5,892 for a married couple.
- Resources of $4,000 for an individual in 2021, or $6,000 for a married couple.
The income and resource limits listed above may increase in 2022. If your income and resources are slightly higher, you should still apply.
Medicare Services & Fees
Eligible recipients of Medicare have a choice. They may enroll into either Original Medicare or into a private health plan known as Medicare Advantage . All plans cover the same basic Medicare-covered health services, but there are differences in premiums, deductibles, coinsurance and provider networks. People should carefully consider their own situations before choosing. If their needs change, people may also change plans during the Open Enrollment period each year.
People enrolling in Original Medicare should also consider enrolling in a stand-alone Prescription Drug Plan , also known as Part D, to cover their outpatient prescription drugs. Most Medicare Advantage Plans already cover prescription drugs.
Below is more detail on coverage provided by Medicare parts A, B, C and D:
Original Medicare members can also enroll in Medicare Supplement Insurance, also called Medigap, which fills in the gaps not covered by Original Medicare. Medigap is offered by private, approved insurance companies. These plans pay for costs such as coinsurance, copayments and deductibles.
In Connecticut, a Medigap cannot be used as a stand-alone plan, and is designed to be used in combination with Parts A and B. These plans do not provide prescription drug benefits. The state offers up to 10 standardized policy options, each labeled with a letter. All plans of the same letter offer the same benefits, no matter which insurance company offers the plan.
How A Dually Eligible Beneficiarys Medical Bills Are Paid
Medicare continues to be a dually eligible beneficiarys primary payer. They are free to seek care from any provider that accepts Medicare. However, Original Medicare offers coverage that is limited in scope. For this reason, many beneficiaries who can afford it choose to purchase a Prescription Drug Coverage Plan , a Medicare Supplement Insurance Policy or a Medicare Advantage Plan to fill these gaps in coverage.
For example, if a full-benefit dual-eligible beneficiary has Original Medicare and a Medigap Plan, then Medigap will function as the secondary payer. Essentially, Original Medicare will pay up to the limits of its coverage and then the secondary payer will pay the remaining costs up to its coverage. Medicaid would then function as the tertiary payer and cover any qualifying expenses that Medicare and Medigap do not.
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What Is The Medicare Savings Program
There are four types of Medicare Savings Programs:
- Qualified Medicare Beneficiary Program
- Specified Low-Income Medicare Beneficiary Program
- Qualifying Individual Program
- Qualified Disabled and Working Individuals Program
If you answer yes to these 3 questions, to see if you qualify for assistance in your state:
If you qualify for the QMB program, SLMB, or QI program, you automatically qualify to get Extra Help paying for Medicare drug coverage.
Find Cheap Medicare Plans In Your Area
In the United States, there are currently two government-provided health insurance policies that citizens can enroll in: Medicare and Medicaid. While they both provide general health insurance benefits, there are differences in eligibility and coverage that are crucial to identify and be aware of the largest being that Medicare is available to adults who are over 65 years old whereas Medicaid is only available to low-income families.
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What Are Dual Special Needs Plans
Dual health plans are also known as dual special needs plans. Theyre offered by private insurance companies, so you can find a dual health plan that best meets your health insurance needs. Being on a dual health plan does not change your Medicaid eligibility or benefits.
See UnitedHealthcare plans in your area.
Please note that the specific benefits dual health plans include can change depending on where you live. Search by your ZIP code to find the right plan to meet your health care needs.
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Looking for the federal governments Medicaid website? Look here at Medicaid.gov.
Are There 2 Types Of Medicaid
There are two general types of Medicaid coverage. Community Medicaid helps people who have little or no medical insurance. Some states operate a program known as the Health Insurance Premium Payment Program . This program allows a Medicaid recipient to have private health insurance paid for by Medicaid.
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The Solution: Medicaid Could Make Up The Medicare Difference For You
Some people think that Medicaid is welfare, but that is not true. Medicaid covers medical expenses, long-term care services, case management, and much more. Medicaid is a different program than Medicare.
Medicaid is for people whose incomes are close to the federal poverty line. Today, Medicaid provides extra help paying doctor bills, hospital bills, and prescriptions for millions of Americans aged 65 and over. If you fall into this category, then youll want to take a close look at your Medicaid eligibility.
Not Limited to Seniors
Others besides seniors can receive Medicaid benefits In all states, Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states the program covers all low-income adults below a certain income level. People with a disability or certain medical conditions may qualify for Medicaid at any age.
Medicare Vs Medicaid 101
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ON SCREEN TEXT: Medicaid 101
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ON SCREEN TEXT: Medicaid is a joint federal and state health program. Federal State
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ON SCREEN TEXT: It is for individuals, families and children with limited income & resources.
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ON SCREEN TEXT: Each state creates its own Medicaid programs based on federal guidelines.
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ON SCREEN TEXT: Medicaid programs have mandatory benefits & optional benefits.
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ON SCREEN TEXT: Medicaid costs will vary based on a person’s income and the state’s Medicaid rules.
ON SCREEN TEXT: Eligibility varies based on a state’s Medicaid rules.
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Medicaid Services Waivers & Fees
Some health care services are covered under Medicaid. For a full list of services covered and detailed explanations, consult the HUSKY Health Program Member Handbook. Download and/or print the handbook for your reference. HUSKY Health also includes enhanced services that have additional requirements. These benefits are below.
Community First Choice is a program in Connecticut offered to active Medicaid members. It allows individuals to receive supports and services in their home. These services include, but are not limited to, help to prepare meals and doing household chores, and assistance with activities of daily living . Go here for more information about Community First Choice and start the CFC Application online here.
Home and Community Based Services Medicaid Waivers help people who are financially and functionally eligible receive long-term Services & Supports in their homes.
Money Follows the Person Program is for Medicaid recipients in care facilities such as nursing homes, hospitals and other qualified institutions. The program can help people successfully transition back into the community.
Unitedhealthcare Connected Benefit Disclaimer
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.
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Medicare Vs Medicaid Compare Benefits
In the context of long term care for the elderly, Medicares benefits are very limited. Medicare does not pay for personal care . Medicare will pay for a very limited number of days of skilled nursing . Medicare will also pay for some home health care, provided it is medical in nature. Starting in 2019, some Medicare Advantage plans started offering long term care benefits. These services and supports are plan specific. But they may include:
- Adult day care
When Will Your Coverage Start
That depends on when you enroll in a dual health plan.
|If You Enroll:|
|When you first become eligible||The first day of the month you qualify for Medicare|
|In a Special Enrollment Period||The first day of the next month|
|In the Annual Enrollment Period||The first day of the next year|
|Note: if your SEP also happens to be during AEP, your coverage will begin the first day of the next month.|
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I Have Been Receiving Health Care Through Medicaid Will I Lose This Coverage When I Become Eligible For Medicare
En español | You will not lose Medicaid eligibility just because you become entitled to Medicare. As long as your income falls under the limits for Medicaid eligibility in your state, you will receive both types of coverage. More than 8 million people have both Medicare and Medicaid.In this situation, Medicare becomes your primary insurance and settles your medical bills first and Medicaid become secondary, paying for services that Medicare doesnt cover and also paying most of your out-of-pocket expenses in Medicare .When you become eligible for Medicare, you must begin receiving your prescription drug coverage from Medicares Part D drug program, not from Medicaid. You will automatically qualify for the federal Extra Help program, which enables you to receive Part D drug coverage without paying premiums or deductibles and paying only low copays for your drugs. But to get this coverage, you still have to choose a Part D drug plan and enroll in it. To ensure that you pick a plan that gives you maximum coverage at the lowest cost, you may want to contact your state health insurance assistance program , which provides personal help from trained counselors on all Medicare and Medicaid issues free of charge. To find the main toll-free number of your SHIP , go to www.shiptacenter.org and select your state. For more information on the Extra Help program, see section 2 of AARPs consumer guide to the Part D program.