Having both Medicare and Medicaid, commonly referred to as “dual-eligible” status, is indeed possible. This unique status provides individuals with comprehensive healthcare coverage, and there are some important aspects to understand about this dual enrollment.
Medicare was created by the Social Security system to protect individuals aged 65 and older and those with certain disabilities. It comprehends two main parts: Part A, which covers hospital expenses, and Part B, which extends coverage to outpatient services. It serves as the primary healthcare coverage for seniors and those with qualifying disabilities.
How to Qualify for Medicare and Medicaid at the Same Time
Different is the Medicaid program, designed to assist low-income individuals, including pregnant women and children, in covering their medical expenses. Even though they work apart, you could get both at the same time. Eligibility for Medicaid is determined based on income and varies depending on the state you reside.
It acts as a secondary payer for dual-eligible beneficiaries, covering costs that are not fully or partially addressed by Medicare. Medicaid assists beneficiaries with premiums, deductibles, co-payments, and coinsurance, making healthcare more affordable for those with dual eligibility status.
Beyond basic medical coverage, some states provide additional services such as medical transportation, vision care, dental care, chiropractic care, and extended nursing facility care that surpasses the 100-day limit under Medicare. Additionally, dual-eligible individuals may have the option to enroll in a Medicare Advantage plan (Medicare Part C), which is offered by private insurance companies approved by Medicare. These plans offer an alternative means to receive Medicare benefits and often include extra perks like prescription drug coverage, dental, vision, and hearing services.
Now, here’s what you’ve been wondering so far: how a person could qualify for both Medicaid and Medicare programs? Dual eligibility occurs when an individual meets the criteria for both Medicare and Medicaid. This typically happens with low-income seniors and individuals with disabilities who are eligible for Medicaid due to their income and Medicare due to age or disability status.
When someone qualifies for both programs, they may receive comprehensive healthcare coverage, including assistance with Medicare premiums, co-payments, and coverage gaps, providing them with access to a broader range of healthcare services.
Applying for Medicare: Who Gets to Qualify?
As stated before, individuals become eligible for Medicare at the age of 65. This includes U.S. citizens and permanent residents who have lived in the country for at least five years. People under the age of 65 can also qualify for Medicare if they have been receiving Social Security Disability Insurance (SSDI) benefits for at least 24 months.
Regardless of age, individuals with rare conditions, such as End-Stage Renal Disease (ESRD) can qualify for Medicare if they require regular dialysis or a kidney transplant. Another qualifying condition is Amyotrophic lateral sclerosis (ALS): people with it automatically qualify for Medicare, no matter their age.
There’s another nice thing here: most beneficiaries are automatically enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance) when they turn 65. If you’re not receiving Social Security benefits, you may need to actively enroll during specific enrollment periods to avoid late enrollment penalties.
Some individuals choose to supplement their Medicare coverage with private insurance plans known as Medigap or opt for Medicare Advantage plans, which provide additional benefits beyond original Medicare.
Basic Requirements to Be Eligible for Medicaid
To qualify for Medicaid in the United States, individuals could comply to factors such as household size, income level (usually based on the federal poverty level), citizenship or legal immigration status, and specific categorical requirements like age, disability, pregnancy, or having dependent children.
Eligible individuals must be below some specific income threshold, which is based on factor like household size and the state you reside in. In some states, Medicaid expansion under the Affordable Care Act (ACA) has increased income limits.
As well as for Medicare, you must be a U.S. citizen or a qualified immigrant to be eligible for Medicaid. Additionally, you must be a resident of the state where you’re applying for Medicaid. Some states have asset or resource limits in addition to income limits. This means that not only should your income be below a certain threshold, but your countable assets, such as bank accounts and property, should also be below a specified limit.