Medicare and Medicaid are useful for those who have a lower income. Some may assume these automatically go together, similar to the way one can get Medigap to further help with Medicare costs. You can qualify for one, but not the other. For instance, you may not qualify for Medicare because you do not meet the age requirement, but you can get Medicaid because of low income status. Likewise, you may qualify for Medicare because you’re 65, but you can’t get Medicaid because you do not have a lower income. You can obtain the benefits of both Medicare and Medicaid if you are under a certain set of circumstances. Let’s look at the various aspects of dual eligibility.

What benefit does Medicaid offer?

Medicaid is specifically targeted toward those with a lower income. Medicaid can cover healthcare costs in addition to certain services (e.g., personal care) that Medicare does not cover. As far as what constitutes “lower income”, that is determined by the state you live in. Each state has its own rules for eligibility. The amount of income is based on Modified Adjusted Gross Income (MAGI).

Medicaid has benefits that it is legally required to give you. Lab work, x-rays, at-home healthcare, and transportation to healthcare facilities are all the benefits that you will get when you get Medicaid. You may even opt for speech therapy, physical therapy, chiropractic care, or podiatry appointments.

Why would I want both Medicare and Medicaid?

Having both Medicare and Medicaid can help because:

• Having two providers pay expenses is better than one
• This allows you to get coverage for services that one may not offer

What determines dual eligibility?

Dual eligibility comes down to meeting the basic requirements for each program. You are eligible if you meet each of the following criteria:

• You’re 65 or older. Or if under 65, you have been automatically enrolled due to receiving benefits such as Social Security or disability (if you have been on disability for 24 months)
• It has been determined that your Modified Adjusted Gross Income is low enough by your state’s standards

If you have any questions

When it comes to finding the right plan for you, it can be overwhelming. But you don’t have to be overwhelmed. We want to make sure that you are satisfied and get the most affordable health care possible. Call us at (509) 993-9887 today.