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What Happens to Medicaid When You Turn 65

Transitioning from Medicaid to Medicare When You Turn 65

These programs are a lifeline for millions of Americans on Social Security or Medicaid. For millions of Americans who qualify, these programs are a lifeline. They provide essential support, ensuring access to healthcare services and financial assistance. 

As you approach 65, you may face a shift in your healthcare coverage: enrolling in Medicare. This transition requires careful consideration, especially understanding how these two crucial healthcare programs intersect and how they may affect you if you’re accustomed to Medicaid benefits.

This article will discuss some common scenarios related to this transition and what you can do. 

Understanding the Key Differences Between Medicare and Medicaid

What Happens to Medicaid When You Turn 65?

These programs are a lifeline for millions of Americans on Social Security or Medicaid. For millions of Americans who qualify, these programs are a lifeline. They provide essential support, ensuring access to healthcare services and financial assistance. 

As you approach 65, you may face a shift in your healthcare coverage: enrolling in Medicare. This transition requires careful consideration, especially understanding how these two crucial healthcare programs intersect and how they may affect you if you’re accustomed to Medicaid benefits.

This article will discuss some common scenarios related to this transition and what you can do. 

Applying for benefits while receiving Medicaid 

If you are on Medicaid, you must apply for any benefits you may be eligible for.  You may wonder, “Why would I not apply for any benefits I am eligible for?” 

Consider one scenario: You are on Medicaid and turn 62. That is when you can receive Social Security benefits, and so you register for Social Security. However, you may no longer qualify for Medicaid due to that additional income. 

Consider another scenario: You are on Medicaid, and your 65th birthday is approaching. What happens now that you can receive Medicare coverage?

Dual Coverage: Receiving Medicare and Medicaid

Medicare and Medicaid serve distinct healthcare needs for different demographics. 

Medicare is a federal program that includes various segments covering hospital care, medical services, and prescription drugs. It’s generally independent of income, with beneficiaries responsible for premiums and copayments. 

Medicaid is a state initiative that received federal support. It extends healthcare coverage to low-income individuals. It is primarily income-based, offering a more comprehensive array of services, including long-term care, and often does not require premiums.

Once you turn 65, you become eligible for Medicare, regardless of your existing coverage. Even if Medicaid currently covers your health insurance, you must apply for Medicare. This transition often means that millions are enrolled in both Medicaid and Medicare at the same time. Over 12 million Americans are enrolled in both of these programs. 

What are Dual Eligible Special Needs Plans (D-SNPs)? 

A Dual Eligible Special Needs Plan is a Medicare Advantage plan. It is a special needs plan that is available if you qualify for both Medicare and Medicaid. D-SNPs integrate multiple coverages, streamlining your benefits for dual-eligible individuals. States regulate the D-SNPs available and review the specific benefits offered within these plans.

If you qualify for both plans, you can likely enroll in a Dual Special Needs Plan.  Eligibility criteria typically include being a U.S. citizen or a lawful permanent resident, qualifying for Original Medicare (Parts A & B), meeting income requirements for your state’s Medicaid program, and residing in an area with a D-SNP available. 

At The Medicare Family, we are happy to help you determine if you reside in a service area with D-SNPs available. Please reach out to us to learn more. 

Preparing for the Transition When You Sign Up For Medicare 

Transitioning to Medicare can bring unexpected challenges, like errors in the system or accidentally losing Medicaid coverage. 

Sometimes, there are issues with old or inefficient computer systems, leading to mistakes that stop your Medicaid coverage when you turn 65. Additionally, there may be mix-ups moving from a state-run program (Medicaid) to a federal one (Medicare), causing delays or errors in coverage.

Understanding your Medicare and Medicaid Coverage With The Medicare Family

As your health coverage changes, it is helpful to clearly understand the process and have a thoughtful plan in place. Many seniors find the process more manageable when they have the proper support. 

The Medicare Family can provide essential guidance and assistance, ensuring you make well-informed decisions matching your unique healthcare needs and financial situation. With four decades of experience in the field, we possess the expertise necessary to offer personalized assistance tailored to your specific circumstances. Schedule an appointment to pave the way for a more stable and secure healthcare future as you transition to Medicare. 

Sylvia Gordon, aka Medicare Mama®, is an expert on all things Medicare and Social Security. She is the 2nd Generation here at The Medicare Family and has served on the advisory boards of major insurance companies like UnitedHealthcare®, Cigna, and Anthem. In her free time, she can be found taking care of her animals (dogs, goats, peacocks, chickens), and reading a good book. Learn More.
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