How To Get Both Medicare And Medicaid


Medicaid Services Waivers & Fees

Medicaid & Medicare: Dual Eligibility Plans (DSNP)

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.

Q How Can I Find Out If I Can Get Medicaid

A. You can find out if you qualify for Medicaid or other medical assistance and social service programs by speaking with a representative at your local State Service Center. Call Medicaid Customer Relations at 1-800-372-2022 or 255-9500 to be directed to the appropriate office where someone can help you.

What Do I Need To Qualify For Medicaid

Medicaid eligibility is primarily based on state income guidelines. Each state has different income limits and they administer their plans differently. To qualify, youll need your social security number and those of your children . Youll also need proof of income and whether or not you receive other government assistance such as WIC or Food Stamps. Youll also want documentation of any disability you or your children may have.

You can apply for Medicaid either online through the Health Insurance Marketplace or through your states Medicaid agency. Medicaid also includes the CHIP program which is the program for children in low-income households. Even if you dont qualify based solely on income, certain disabilities, pregnancy, and the elderly may still qualify for aid.

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Q If I Have Private Health Insurance Can I Be Eligible For Medicaid

A. It depends. If your income is low, and you have minor children, you and your children can have private health insurance and still be eligible for Medicaid. Certain Medicaid qualifying programs require that you not have any other health insurance in order for you to get Medicaid. If you have both private health insurance and Medicaid, you should show both your Medicaid card and your private health insurance card to your medical provider each time you receive services.

What Are The Differences Between Medicare And Medicaid

What is the difference between Medicare and Medicaid?

Medicare is a federal health insurance program open to Americans aged 65 and older, and those with specific disabilities who are under the age of 65. Medicaid, a combined state and federal program, is a state-specific health insurance program for low-income individuals with limited financial means, regardless of their age.

Medicare, generally speaking, offers the same benefits to all eligible participants. However, coverage is divided into Medicare Part A, Part B, and Part D. Medicare Part A is for hospice care, skilled nursing facility care, and inpatient hospital care. Medicare Part B is for outpatient care, durable medical equipment, and home health care. Part D is for prescription coverage. Not all persons will elect to have coverage in all three areas. In addition, some persons choose to get their Medicare benefits via Medicare Advantage plans, also called Medicare Part C. These plans are available via private insurance companies and include the same benefits as Medicare Part A and Part B, as well as some additional ones, such as dental, vision, and hearing. Many Medicare Advantage plans also include Medicare Part D.

Medicaid is more comprehensive in its coverage, but the benefits are specific to the age group. Children have different eligibility requirements and receive different benefits from low-income adults and from elderly or disabled persons.

Helpful Resources

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How The Programs Differ

Medicare is an insurance program while Medicaid is a social welfare program.

Medicare recipients get Medicare because they paid for it through payroll taxes while they were working, and through monthly premiums once theyre enrolled.

Medicaid recipients need never have paid taxes and most dont pay premiums for their Medicaid coverage .

Taxpayer funding provides Medicaid to eligible needy people in a manner similar to other social welfare programs like Temporary Assistance for Needy Families Women, Infants and Children and the Supplemental Nutrition Assistance Program.

Whats The Difference Between Medicaid And Medicare

Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income. They will work together to provide you with health coverage and lower your costs.

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How Do I Qualify For Medicare And Medicaid Programs

Luckily for many, the qualifications outlined by Medicare and Medicaid are cut-and-dry, meaning youll have a great understanding of whether youre eligible before you begin the application process. Those who are eligible for Medicares services typically tend to be at least 65 years old. However, you may also qualify for Medicare before the age of 65 if you have been receiving Social Security disability for 24 months, have Lou Gehrigs disease or end-stage renal disease.

Those who have already been receiving Social Security benefits are automatically enrolled in Medicare Parts A and B upon the month they turn 65. Additional coverage options will then be made available for those who are interested. Those who need to manually enroll themselves into a Medicare program can do so through the Social Security Administration . They can enroll through the SSA website, calling 1-800-772-1213 or by visiting their local Social Security office.

After becoming a part of the Medicare program, enrollees can expect to receive welcome packages with their new Medicare card, also known as the Red, White & Blue Card, included. Its important to keep this card close so that you can protect yourself from Medicare fraud, as well as those who could scam you, as many seniors fall victim to scams as it relates to Medicare.

Close To Dual Eligibility Check With Your States Medicaid Office

Dual Eligibility: Choice and Access for Individuals Eligible for Medicare and Medicaid, Judy Feder

As part of the Affordable Care Act, each state was allowed to broaden its Medicaid assistance levels. Some states agreed to expand coverage but others did not. So dont automatically rule yourself out discuss your circumstances with your local social services provider.

The Medicare-Medicaid Coordination Office: Medicaid can be quite confusing. Complexity keeps some people from even applying for Medicaid, even though the application process is quite simple.

To help solve that problem, the federal government runs a Medicare-Medicaid Coordination Office. The office streamlines the experience of getting healthcare to those who need it. They work to develop insurance policies designed to work especially with dual-eligible citizens.

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Q Where Do I Go To Apply For Medicaid

A. There are several ways to apply for Medicaid and other medical assistance programs:

  • On the internet, you can use ASSIST to check your eligibility for several different assistance programs by completing a self-screening questionnaire. ASSIST then allows you to apply online.
  • You may also print an Application for Health Insurance/Medicaid. The application form is also available in Spanish/en Español.
  • By phone, you can contact Medicaid Customer Relations at 1-800-372-2022 or 255-9500 to be directed to the Division of Social Services office closest to where you live. DSS staff members will help you find out more about eligibility for Medicaid and other assistance programs. Then the appropriate information and application forms will be mailed to you. Complete, sign and date the application form in ink and mail it to the address provided.
  • For Long Term Care applications, please call the Long Term Care Medicaid Unit listed for the county where you live.

Do I Qualify For Full Medicaid

  • The eligibility requirements vary from state to state, but generally states consider your annual income and financial assets when determining whether you are eligible for full Medicaid.
  • If you live in one of the 37 states that will have expanded Medicaid as of next January and you earn no more than 138 percent of the federal poverty level , you may qualify. In states that havent expanded the program, the income levels for Medicaid eligibility vary greatly. For all eligibility questions, you should check with your state Medicaid office.
  • If you are a Medicare beneficiary, your enrollment in Medicaid may be subject to a financial asset test. The value of assets youre allowed to have and still be eligible varies from state to state. The federal guidelines allow you $2,000, but some states have higher thresholds while others dont have an asset test at all.
  • Excluded from the $2,000 asset test are such things as your home, one car, some burial expenses, some life insurance and household and personal items. States generally look back at an applicants assets for five years to make sure they havent divested themselves of those resources just to qualify for Medicaid.
  • The asset income limits for Medicare Savings Programs are higher and change every January. For 2018, the limits for those programs are $7,560 for a single person and $11,340 for a married person living with a spouse and no dependents. As with full Medicaid, some states have higher resource thresholds.

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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 persons 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.

Medicare Services & Fees

How to get more benefits from your Medicare and Medicaid ...

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.

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Q What Documents Will I Need To Provide When I Apply

A. You will need to provide verification of your income. You do not need to provide proof of your assets or resources or come into our offices to be interviewed unless you are applying for one of the Long Term Care Medicaid programs .

If you are pregnant, you will need to provide proof that you are pregnant. If you are not a U.S. citizen, you will need to provide proof of your alien status. For example, you can provide a copy of your green card.

If you apply online using ASSIST, a web page at the end of the application will tell you exactly what documents must be sent by mail to support the application you are submitting, and the appropriate mailing address.

Can I Be Enrolled In Medicare And Medicaid At The Same Time

Q: Can I be enrolled in Medicare and Medicaid at the same time?

A: In many cases, yes. Some Americans qualify for both Medicare and Medicaid, and when this happens, it usually means they dont have any out-of-pocket healthcare costs.

Beneficiaries with Medicare and Medicaid are known as dual eligibles and account for about 20 percent of Medicare beneficiaries . Dual eligibles are categorized based on whether they receive partial or full Medicaid benefits.

Full-benefit dual eligibles have comprehensive Medicaid coverage, while partial benefit dual eligibles receive help with Medicares premiums and cost sharing through a Medicare Savings Program .

The federal government oversees Medicare eligibility meaning it is the same in each state. But states set their own eligibility rules for Medicaid and the MSPs and income limits for these programs vary widely.

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What Are The Costs Of Medicare

Medicares monthly premium can range from $0-$104, depending on how much coverage you need. On average, Medicare Part B will cover 80% of all medical services while 20% are paid out-of-pocket by the senior citizen under the plan.

People paying more than their expected share may be eligible for Extra Help through Social Security which pays 100 percent of prescription drug premiums and deductibles each month if they meet eligibility requirements. There is no monthly premium for Part D.

Qualified Medicare Beneficiary Program

“Dual-Eligible for both Medicare and Medicaid” by

This program helps pay for Medicare Part A and Part B premiums, deductibles, coinsurance and copayments.

Eligibility requires:

  • Income of no more than $1,094 per month for an individual in 2021, or $1,472 per month for a married couple
  • Resources of no more than $7,970 for an individual in 2021, or $11,960 for a married couple

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What Is Medicare Extra Help

Extra Help is a federal program that helps pay for out-of-pocket costs related to Medicare prescription drug coverage. Extra Help is also known as the Medicare Part D Low-Income Subsidy

The assistance that Medicare Extra Help may provide includes:

  • Help paying Part D premiums
  • Lowered out-of-pocket costs of prescription drugs
  • An annual Special Enrollment Period to enroll in a Part D plan or switch to a new one
  • Elimination of Part D late enrollment penalties

You automatically qualify for Extra Help if you are enrolled in Medicaid, Supplemental Security Income or a Medicare Savings Program.

You may still qualify for Extra Help if you are not enrolled in any of those programs but still have income and assets below a certain limit.

American Disabilities Act Notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

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What Are The Benefits Of Medicare

As a program that covers seniors, Medicare is known for providing affordable health insurance. This significant benefit is an essential part of the United States healthcare system. It offers many options for people who might not otherwise be able to afford medical treatment or medication.

Medicare has many benefits compared to Medicaid, but the most important one is that Medicare provides more choices for consumers.

How Dual Eligibility Works

The Differences Between Medicare and Medicaid

Logically, there is some overlap between these two programs. A significant number of senior Medicare beneficiaries do not have substantial income or retirement savings to fund their health care and long-term care. Once a Medicare beneficiary has nearly exhausted their financial resources and meets strict state-specific income and asset limits, they may apply for full Medicaid benefits. These individuals are known as full-benefit dual-eligibles.

Read:Qualifying for Medicaid to Pay for Long-Term Care

A senior may also become a dually eligible beneficiary by qualifying for one of four Medicare Savings Programs offered by their states Medicaid program to help pay Medicare premiums and sometimes coinsurance and copayments. These benefits are not as comprehensive compared to the combination of Medicare and full Medicaid, but MSPs feature higher asset limits and more flexible income limits. Individuals who qualify for MSPs are known as partial-benefit dual-eligibles.

Read:Medicare Savings Programs Help Seniors Pay Their Premiums

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How Do Medicare Benefits And Medicaid Work Together

The Centers for Medicare & Medicaid Services manages the social health programs called Medicare and Medicaid. These programs are specially designed to help disabled, senior, and low-income people afford health coverage. These two health insurances cover two different population sectors. Medicaid helps low-income individuals while Medicare benefits are available based on age or disability.

What happens if youre someone who meets the criteria for both? Millions of individuals live on a fixed income, and this can qualify you for Medicaid coverage. Can you have both Medicare and Medicaid coverage, or do you have to choose one? If you qualify, you may be able to be a dual-eligible.

Medicare and Medicaid Team up to Provide Coverage

Many seniors in the United States have dual eligibility for Medicare and Medicaid benefits. Generally, this means that you have enrolled in Medicare, but that you qualify for Medicaid as well due to your income.

When you have dual enrollment, Medicare is your primary insurance that covers any costs first. Medicaid is your secondary payer. Every state has different benefits for people who qualify under dual eligibility, so its important that you check with your local Medicaid office.

How Medicaid and Medicare Benefits Work Together

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