Medicaid

Medicaid is an insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly (65+), and people with disabilities. Many states have expanded their Medicaid programs to cover all people below certain income levels.

Whether you qualify for Medicaid coverage depends partly on whether your state has expanded its program.

Medicaid benefits, and program names, vary somewhat between states. You can apply anytime https://www.healthcare.gov/lower-costs/ if you qualify, your coverage can begin immediately, any time of year.

All states offer a variety of Medicaid programs, with eligibility and coverage specifics varying by state. If you qualify for a Medicaid program, it may help pay for costs and services that Medicare does not cover.

Here are a few examples of how Medicaid can work with Medicare.

• Medicaid can provide secondary insurance: For services covered by Medicare and Medicaid (such as doctors’ visits, hospital care, home care, and skilled nursing facility care), Medicare is the primary payer. Medicaid is the payer of last resort, meaning it always pays last. When you visit a provider or facility that takes both forms of insurance, Medicare will pay first and Medicaid may cover your Medicare cost-sharing, including coinsurances and copays.
• Medicaid can provide premium assistance: In many cases, if you have Medicare and Medicaid, you will automatically be enrolled in a Medicare Savings Program (MSP). MSPs pay your Medicare Part B premium, and may offer additional assistance.
• Medicaid can provide cost-sharing assistance: Depending on your income, you may qualify for the Qualified Medicare Beneficiary (QMB) MSP. If you are enrolled in QMB, you do not pay Medicare cost-sharing, which includes deductibles, coinsurances, and copays.
• Medicaid can provide prescription drug assistance: Dually eligible individuals are automatically enrolled in the Extra Help program to help with their prescription drug costs.
• Medicaid can offer care coordination: Some states require certain Medicaid beneficiaries to enroll in Medicaid private health plans, also known as Medicaid Managed Care (MMC) plans. These plans may offer optional enrollment into a Medicare Advantage Plan designed to better coordinate Medicare and Medicaid benefits. Note: You cannot be required to enroll in a Medicare Advantage Plan.

Make sure to call 1-800-MEDICARE or contact your local Medicaid office to learn more about Medicare and Medicaid costs and coverage, especially if you are a dual-eligible.