| Mon, Aug 20, 2012 @ 09:00 AM

Medicare and Medicaid Can Work Together

Posted by Medicare Made Clear

medicare medicaid costsMedicare and Medicaid are two separate programs that are often confused.

  • Medicare is a federal program that provides health care coverage for people 65 and older and for people under 65 with certain disabilities.
  • Medicaid is a joint federal and state program that helps pay medical costs for people of all ages with limited income and resources.

People with Medicare who have limited income and resources may get help paying out-of-pocket medical costs from Medicaid. Costs that may be covered include premiums, deductibles, coinsurance and copays.

The federal government sets the income and resource limits for Medicaid. But each state determines what counts when calculating income and resources. So qualification depends in part on where you live.

 “Dual Eligibles”

People who qualify for both Medicare and Medicaid are called “dual eligibles.” Medicare pays first for services that are covered by both programs. If the Medicare payments don’t cover the expenses, then Medicaid may pay the difference up to the payment limit in the beneficiary’s state of residence. Medicaid may also cover some things that Medicare doesn’t, such as long-term care services and more.

Medicare beneficiaries have two paths to receiving full Medicaid benefits. One is meeting the income and resource limit. The other is to have very high medical expenses—high enough to reduce net income below their state’s specified level. People who experience this are considered “medically needy,”and most states have programs to help them. Limited Medicaid benefits may be available to people with somewhat higher incomes.

Extra Help with Drug Costs

Extra Help is a program that assists Medicare beneficiaries with limited income and resources in paying their Medicare prescription drug plan costs. Most people who qualify for Medicaid also qualify for Extra Help, but you may also qualify for one and not the other.

The income limit for Extra Help in 2012 is $16,755  for an individual or $22,695 for a married couple living together. Other financial resources must be no more than $13,070 for an individual or $26,120 for a married couple living together. Limits are slightly higher for those who live in Alaska or Hawaii. Resources include things like bank accounts, stocks and bonds. Homes, cars and life insurance policies do not count when calculating resources.

You can learn more about Extra Help by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778), 7 a.m. to 7 p.m. local time, Monday through Friday.

Help is Available

It’s important to know that there is help available for people who need it and who qualify. Don’t hesitate to ask what may be offered for you or your loved one. You can get more information online at Medicare.gov or SSA.gov. You can also call your State Health Insurance Assistance Program.

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.


Financial Help with Medicare Costs: MedicareMadeClear.com

Medicaid Coverage of Medicare Beneficiaries at a Glance: Medicare publication explaining the two programs and how they can work together

Help with Medical and Drug Costs: Medical assistance information on Medicare.gov

Y0066_120621_081854 CMS Accepted