How Medicaid works with Medicare
Many of the millions of Medicare enrollees in the United States are at least 65 years old; however, Medicare is also available to younger people with qualifying disabilities. You may be eligible for Medicaid if you meet income and resource limit requirements. Each state administers its Medicaid program and may have different eligibility requirements and expanded benefits. Check for your state’s definitions and eligibility standards for Medicaid here. Or, contact your State Health Insurance Assistance Program (SHIP) to speak with an unbiased agent about how Medicare and Medicaid will work for you.
Dual Eligible Standards
Medicare is available if you’re at least 65 years old or have some disability, such as amyotrophic lateral sclerosis (ALS), that qualifies you for Social Security Disability Income (SSDI) benefits. To receive premium-free Part A coverage, you must have worked and paid Medicare taxes for a minimum number of quarters. You must also be a U.S. citizen or lawful permanent resident.
Qualifying and Applying for Medicare and Medicaid
Medicaid eligibility requirements can be confusing, especially for applicants under 65 who get Medicare coverage for a qualifying disability. Area Agencies on Aging have trained counselors on hand to answer questions about Medicare and help current Medicare beneficiaries determine if they might be dually eligible. AAA counselors can also help you determine if you’re eligible for the QMB, SLMB, QI, or QDWI programs.
Some communities have geriatric care managers available to assist. A geriatric care manager is a registered nurse or social worker who has been trained to help older adults access health and social services. In addition, elder care attorneys, State Health Insurance Assistance Program counselors, and commission-based Medicaid planners are also good resources for information on Medicaid eligibility and benefits.
As long as they cover mandatory benefits required by CMS, states can implement cost-sharing arrangements as part of their Medicaid plans. CMS caps out-of-pocket costs, but state Medicaid programs are also allowed to charge a premium for enrollees in the following groups: