Will you lose Medicaid if you get Medicare?
Over 12.5 million people in the United 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 well-being. People on Medicaid rely on the program, so, understandably, 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, what plan options exist for people who are eligible for both.
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.
Individuals who are dually eligible for Medicaid and Medicare usually benefit from more comprehensive coverage, though there may still be some gaps in coverage depending on their state’s standards for benefits and coverage.
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 take a step back to understand the differences between the two programs.
What is Medicaid?
Medicaid is a program that provides essential health coverage to people with low incomes and limited resources. Both state and federal governments fund Medicaid, which is why Medicaid rules and eligibility requirements vary by state. Medicaid offers benefits that Medicare doesn’t typically offer, including nursing home care and personal care services. Medicaid beneficiaries usually don’t pay for covered expenses, like hospital stays, doctor visits, prescriptions, and preventive care. However, some items or services may require a small copayment. 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.
What is Medicare?
Medicare is a federal program that provides health coverage for people aged 65 and older and people with certain disabilities. Original Medicare (also called Traditional Medicare) includes Part A and Part B and covers roughly 80% of healthcare costs. Additional Medicare coverage options, including Part C, Part D, and Medigap, can help to reduce the remaining 20% out-of-pocket costs. In contrast to Medicaid, the federal government determines regulations for Medicare coverage and requirements. Because of these federal standards for costs and coverage, a person’s Original Medicare coverage and costs are the same no matter what state they live in. Coverage and pricing can vary when you look at Medicare coverage separate from Original Medicare.
Notable differences between Medicare and Medicaid
Below are some of the key ways to tell Medicare and Medicaid apart:
Regulations: Medicare is a federal program that has set standards for cost and coverage. Medicaid is run by both state and federal governments, which is why coverage and benefits vary from state to state.
Costs: People with Medicaid don’t usually pay for the insurance or health care services. People with Medicare pay monthly premiums to obtain insurance as well as part of the costs of their services through deductibles and coinsurance.
Eligibility: People 65 and older are eligible for Medicare. People with certain disabilities or conditions may also qualify for Medicare at a younger age. Medicaid eligibility is dependent on your income and resources and varies from state to state.
Will you lose Medicaid if you get Medicare?
Both Medicaid and Medicare offer critical coverage for healthcare services for vulnerable and older individuals. Together, they create a comprehensive healthcare safety net for those who need it most.
In most cases, you won’t lose Medicaid if you sign up for Medicare, as long as you’re eligible to receive assistance from both programs. This is also referred to as “dual eligibility.” For example, a person with dual eligibility may qualify for Medicare when they reach the age of 65 while also meeting their state’s criteria for Medicaid because of their income.
Dual-eligible individuals can benefit from more comprehensive coverage than individuals who are only covered by Medicare. But some people with dual eligibility may still have some gaps in coverage.
States have different coverage and qualification guidelines 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 qualify for both Medicare and Medicaid. These plans are tailored to the specific needs of the dual-eligible population. They provide 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 work together to ensure you have access to affordable healthcare. When you have Medicare and Medicaid, Medicare pays for bills first, 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. However, benefits vary by state, 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.
Bottom line
You won’t lose Medicaid coverage when you enroll in Medicare as long as you remain eligible for both programs. Certain plans, including the Dual Eligible Special Needs Plans (D-SNPs) and Medicare Extra Help program, can offer additional support for dual-eligible individuals to help cover healthcare and prescription drug costs.
But losing your Medicaid healthcare coverage can still 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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