Medicare and Medicaid

What do I need to know if I have Medicare and Medicaid?

Medicaid is a joint federal and state program that helps pay medical costs if you have limited income and resources and meet other requirements. Some people qualify for both Medicare and Medicaid and are called “dual eligible”. Each state offers a variety of Medicaid programs that assist Medicare beneficiaries with their original Medicare Part A (hospital) and Part B (medical) related out-of-pocket expenses and/or premiums. If you qualify for Medicaid assistance Medicare will be your primary coverage (or pays first) and then Medicaid will assist with the out-of-pocket expenses (also known as “cost-sharing”) not paid by original Medicare or your Medicare Advantage (also known as “Part C) plans. Medicaid may help pay for costs and services that Medicare does not cover.

Financial eligibility guidelines and covered services vary greatly from state to state and from program to program. Be aware that you may be able to have higher income than general eligibility guidelines suggest because certain income may not be counted, or you may be able to qualify another way. An example of qualifying with a higher income is “spending down” your income on medical expenses. Spend down lets you reduce or spend down your excess income to bring it within the Medicaid program limit. Excess income is the amount of income you have over the program limit. The spending down process uses medical bills as income deductions. The medical bills are subtracted from the excess income. The more bills you subtract, the lower the excess income gets. Once the excess income is used up, you become eligible for Medicaid. There are stipulations and guidelines regarding the medical bills you can use toward the spending down process. Contact your local Medicaid office for additional information regarding the spending down process.

Why should I get a Medicare Advantage Plan if I have Medicaid?

Qualifying for Medicaid does not mean that you do not need to purchase private insurance like a Medicare Advantage plan. Medicaid is available to assist the Medicare beneficiary with the cost-sharing but not to bear the burden of covering all of the expenses not paid for by original Medicare Part A and Part B. There are many services a Medicare Advantage plan can offer that may not be included in Medicare or Medicaid.

Extra services a Medicare Advantage plan can offer are:

  • Dental
  • Vision
  • Hearing
  • Gym Membership
  • Transportation
  • Built in Drug Plan

Medicaid will assist the Medicare beneficiary with deductibles, co-payments and co-insurances associated with their private health insurance plan such as a Medicare Advantage plans. The Center for Medicare and Medicaid Services will determine the percentage of your premium or portions of your cost-sharing in which Medicaid will assist.

If you qualify for Medicaid assistance you should automatically be enrolled in a Qualified Medicare Beneficiary (also known as “QMB”) program. Once enrolled in the program Medicaid will offer additional assistance beyond the Medicare related cost-sharing, or co-payments and co-insurances, by paying your Medicare Part B premium. If you qualify for Medicaid and the Social Security Administration is still deducting your original Medicare Part B premium ($99.90 in 2012 and 2013) then you need to contact your local Medicaid office to enroll in a Qualified Medicare Beneficiary program.

If you have Medicare and Medicaid and are in a Qualified Medicare Beneficiary program, you should be able to go to any doctor or medical facility that accepts Medicare and Medicaid assignment without having to pay the deductibles, co-payments or co-insurances associated with original Medicare or your Medicare Advantage plan. However, if your private insurance plan has a network of physicians and medical facilities it is highly recommended that you adhere to your private health plan’s network because each state has different rules regarding the payment of deductibles, co-payments and co-insurances. You may still have to pay a portion of the deductible of your private insurance plan, if applicable, or you may still have to pay co-payments or co-insurances associated with your private insurance depending on your state’s rules. Your provider should be aware of the rules of the state you are residing in and bill correctly for services provided. If you have questions regarding whether or not your provider is correctly billing contact your local Medicaid office for assistance.

There are other Medicare Savings Plans available in. For more information regarding guidelines and the assistance programs contact your state Medicaid office.

A Benefit Specialist at Medicare Pathways will assist you in determining an appropriate Medicare Advantage Plan to go with your Medicaid. Call 1-866-466-9118. Medicare Pathways’ Benefit Specialists are highly trained agents who will take into consideration your personal and financial situation in determining your private insurance plan that works with your original Medicare. Medicare Pathways is a national company and the Benefit Specialists are licensed in many states throughout the United States. Contact a Benefit Specialist today by calling 1-866-466-9118 or request a quote online.

 

Are you in need of further assistance? Curious as to what you are eligible for? Give us a call now for more information. Contact a licensed insurance agent at Medicare Pathways by calling 1-866-466-9118.