Medicare and Medicaid are government programs that pay medical expenses for people who meet the eligibility requirements for each program. Medicare is a federal program for people who are aged 65 and older. It also provides benefits to younger individuals who qualify for Medicare because of a disability or who suffer from a chronic medical condition. Funding for Medicare is through taxes workers pay on their wages and self-employment income.
Medicaid is a joint state and federal program providing payment of medical expenses incurred by people with limited income and resources. Each state administers its program and sets its own eligibility and benefit rules as long as it complies with general rules set by the federal government.
It is possible for someone to qualify for Medicaid and Medicare to get benefits from both programs and pay little or nothing for prescription medications and their other health care needs. “Dual eligibility” describes when a person qualifies for both programs. This blog explains dual eligibility, including what it takes to be eligible for it and the benefits you’ll receive if you qualify.
How Do Medicare And Medicaid Work?
If you worked long enough and paid into the Social Security retirement system through taxes on your earnings, you qualify for Medicare at age 65. You may qualify for Medicare at a younger age if you are disabled and qualify for Social Security disability or have a chronic medical condition, such as end-stage kidney disease. Talk to a disability lawyer at Liner Legal to learn if you have a medical condition that may qualify for SSD.
- Original Medicare has two parts: Part A pays for health care services in a hospital or long-term care facility. Part B pays toward outpatient services, including office visits with your doctor. Eligible beneficiaries receive Medicare Part A without paying a premium. Part B coverage is optional, so it has a monthly premium.
Each state has its own Medicaid program, so the eligibility requirements and extent of the benefits you receive differ depending on where you live. Medicaid programs limit eligibility to low-income people with few assets or resources.
What Is The Advantage Of Qualifying For Both Medicare And Medicaid?
The advantage of qualifying for both Medicare and Medicaid is that it could reduce or eliminate Medicare premiums and out-of-pocket expenses for healthcare services and prescription medications. Dual eligibility also may give you access to Medicaid benefits for services that Medicare does not pay toward, including the following:
- Dental care
- Vision care
- Hearing aids
- Wellness programs
- Prescription medications
Medicare becomes your primary coverage for health care with Medicaid as the secondary payer of benefits. All you need to do is show your Medicare and Medicaid identification cards to the service provider.
If you are disabled and have been for benefits through Social Security Disability Insurance, you must wait 24 months before becoming eligible for Medicare. Depending on your monthly income and resources, you may qualify for Medicaid in your home state. As you wait for Medicare eligibility, Medicaid fills the gap and becomes the secondary payer when Medicare coverage begins.
How To Qualify For Dual Eligibility?
The following are the four general types of dual eligibility distinguished by the Medicare coverage type and the level of assistance from Medicaid:
- Qualified Medicare Beneficiary: Qualified Medicare beneficiaries have Medicare Part A and Part B coverage and qualify for all of the Medicaid benefits available through their state. Medicare is the primary coverage, but Medicaid pays all Medicare premiums and health care costs not paid by Medicare. Your income must be below the federal poverty level of $1,225 monthly countable income for individuals in 2023 and $1,663 monthly for married couples. Assets may not have a value above $9,090 for individuals and $15,130 for married couples.
- Specified Low-Income Medicare Beneficiary: If you have Medicare Parts A and B, but your income is too high to be a qualified Medicare beneficiary, you may be eligible as a specified low-income Medicare beneficiary as long as your monthly countable income in 2023 is less than $1,478 as an individual or $1,992 monthly for couples. The asset values remain the same as for qualified Medicare beneficiaries. If you qualify as a specified low-income Medicare beneficiary, Medicaid may pay your Medicare Part B premium depending on the benefit rules for your state.
- Qualifying Individual: You must have Medicare Parts A and B with a countable monthly income in 2023 that is less than $1,660 for individuals or $2,238 for married couples. Asset levels remain the same as for the other dual eligibility programs. If you qualify, Medicaid will pay the Part B premium, depending on the benefit rules in your state. You must apply each year for benefits as a qualifying individual because funding is limited and is awarded on a first-come basis.
Income and asset levels are subject to change each year, so you should apply now if you think you are eligible for both Medicare and Medicaid.
Get Help From An Experienced Disability Lawyer
Eligibility rules for Medicare, Medicaid, and Social Security disability can be confusing, but help is available at Liner Legal Disability Lawyers. Our team of experienced disability lawyers has helped thousands of people obtain the disability benefits they deserve. Contact Liner Legal today for a free consultation to learn what we can do for you.
