Over 12.5 million people in the States have both Medicaid and Medicare. People who are eligible for both programs benefit from low-cost healthcare and financial assistance for expenses related to their health and wellbeing. People on Medicaid rely on the program, so it’s completely understandable that you may be worried about losing your Medicaid benefits when you become eligible for Medicare.

Fortunately, Medicaid enrollees will not lose their benefits if they sign up for Medicare. As long as you are eligible for both programs in your state, you will continue to receive benefits from both Medicaid and Medicare. Things will work a little differently though.

In this post, we’ll explain how the programs work together, plan options available only for people who are eligible for both programs, and other options you have for financial assistance tied to healthcare if you do lose Medicaid.

Key takeaways:

  • You won’t lose Medicaid when you enroll in Medicare if you are qualified for both programs. However, every state has different requirements for Medicaid. Check with your state to make sure you can receive benefits from both programs.

  • If you need help understanding your Medicare and Medicaid benefits, we can help! Call us at 855-900-2427 or pick a time to talk.

What is the difference between Medicaid and Medicare?

Before we take a look at how Medicare and Medicaid work together, let’s back up and see what the differences between the programs are. 

Medicaid is a program that provides health coverage to people with low-incomes and resources. Both state and federal governments run Medicaid, which is why Medicaid rules and eligibility requirements vary by state. You can get in touch with your state’s Medicaid office or State Health Insurance Assistance Program (SHIP) to learn more about qualifications and benefits where you live.

Medicare is a federal program that provides health coverage for people aged 65 and older and for people with certain disabilities. In contrast to Medicaid, the federal government determines regulations for Medicare coverage and requirements. 

Will you lose Medicaid if you get Medicare?

No, most of the time you won’t lose Medicaid if you get Medicare as long as you’re still eligible to receive assistance from both programs. States have different rules for coverage and qualifications for Medicaid. If you live in a state where you meet the income and age or disability requirements for Medicare and Medicaid, you won’t lose coverage for Medicaid. 

Note: You automatically qualify for Medicare and Medicaid if you receive both Social Security Disability Insurance (SSDI) and Social Security Income (SSI).

Dual Eligible Special Needs Plans (D-SNPs)

Dual Special Needs Plans (D-SNPs) are a type of Medicare Advantage plan for people who are qualified for both Medicare and Medicaid. These plans are tailored to the specific needs of the dually eligible population by providing additional support for healthcare costs, healthcare management, day-to-day finances, and greater drug coverage. If you are eligible for Medicare and Medicaid, you’re eligible for a D-SNP if it's available in your county. 

How Medicare and Medicaid work together

The programs coordinate together to ensure your healthcare costs are low. When you have Medicare and Medicaid, Medicare pays first for any medical bill, then Medicaid helps cover any remaining expenses (such as out-of-pocket costs for copays and deductibles). Medicaid can also help cover services that Medicare doesn’t, like long-term care, dental care, and transportation. Benefits vary by state, however, so be sure to check what’s covered by plans available in your state.

Medicare Part D coverage with Medicare and Medicaid

Medicaid and Medicare don’t automatically come with prescription drug coverage. Medicare beneficiaries may receive drug coverage through a standalone prescription drug (Part D) plan or through a Medicare Advantage plan. If you have Medicaid and Medicare, you qualify for the Medicare Extra Help program, which reduces the cost of your prescriptions.You’ll need to enroll in a Medicare plan that includes Part D coverage to receive Extra Help benefits. Part D plans vary in what drugs they cover, so make sure that you choose a plan that meets your health needs.

Losing your Medicaid healthcare coverage can be a scary thing to think about. We recommend talking to a Chapter Medicare Advisor, who can help you better understand both programs and how they work together to provide you with affordable, high-quality health insurance. 

We can assist you with:

  • Understanding your state’s qualifications for Medicaid and Medicare

  • Choosing a plan that covers the benefits you need

  • Using all the benefits that come with your current plan 

Our advice is completely free! Call us at 855-900-2427 or pick a time to chat.

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