Medicare is a comprehensive health care plan, but one that Americans must pay for via deductibles and premiums. Those who have low income may be eligible for Medicaid in addition to Medicare. This is known as dual eligibility and means those who are unable to pay Medicare-related expenses can still access the medical services they need.
Medicare and Medicaid are two separate programs, each with different eligibility requirements. Individuals must enroll on Medicare and Medicaid separately. All seniors who are eligible for retirement Social Security benefits are entitled to Medicare. In addition, many people who are living with a disability will be able to claim Medicaid.
Eligibility for Medicare is set at a federal level, which means the standards are the same nationwide. In contrast, Medicaid is administered by individual states. There are federal mandates to cover certain groups, such as those who have an income that is below 133% of the federal poverty level. Outside of those mandates, however, each state can set its own requirements for Medicaid.
There are four programs covering those who are dual-eligible beneficiaries. They are:
In addition to Medicaid, many seniors may be eligible for other assistance, depending on the state they reside in. For example, many states offer a Home and Community Based Services waiver that provides support with all or part of the cost of assisted living or other long-term care. These waivers can help seniors who require support beyond the hospital stays, prescriptions and other services covered by Medicare.
Seniors who are unsure about how Medicare works or who would like to know more about their coverage options can seek advice from their local State Health Insurance Assistance Program (SHIP). SHIP is a free service that offers unbiased, reliable Medicare counseling and assistance to help people find the best coverage for their needs.