Medicare with Medicaid

With names that are so similar, it’s easy to confuse Medicare and Medicaid with each other. They both are government assistance programs, but they focus on two different groups of people: the elderly and those with low-income.

Sometimes, people will have both Medicare and Medicaid. We explore how they work together in this article.

Medicare vs. Medicaid — Whats the Difference?

Medicare is federal health insurance for people age 65 or older, and people under 65 with certain disabilities or conditions. Medicare is a federal program, so it’s the same in all 50 states.

Medicaid is a joint federal and state program to help cover medical costs for people below certain income and resource limits. Each state runs their own Medicaid program so the programs (and even the name) varies from state to state.

Medicare vs. Medicaid
For the most part, Medicare is for those age 65+ and Medicaid is for those with limited income. Some people may qualify for both.

How Medicare and Medicaid Work Together

When you qualify for Medicare and Medicaid, there are certain healthcare plans that are designed to coordinate benefits and offer extra coverage not available through either program alone.

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Medicare Dual Special Needs Plans (D-SNP)

Dual Special Needs Plans, also known as D-SNPs, are a special type of Medicare Advantage program that is only available to those people who have Medicare and a certain level of Medicaid.

These plans coordinate with Medicare, Medicaid, and the Part D prescription drug plan company in order to provide a much smoother managed care experience.

For those who qualify, you get the low out-of-pocket expenses of Medicaid with the extra benefits available on Medicare Advantage plans. These extra benefits can be especially attractive when you have limited financial resources.

Qualify for Medicare Medicaid D-SNP Plans

In order to qualify for a Medicare Medicaid plan, the insurance company will specify a certain level of Medicaid that is required.

Qualifying levels of Medicaid depend on the plan, but chances are, if you are “Full Benefit Dual Eligible” you will qualify.

The important piece of the puzzle is for the Medicare insurance broker (that’s us) to verify you qualify before applying, or else the application will be rejected.

Warning: Do not submit a D-SNP plan application without verifying that your level of Medicaid qualifies for the plan.

Drawbacks of D-SNP Plans

The main drawback of a Medicare Medicaid Dual Special Needs plan is that you’ll have to work within the network of the Medicare Advantage company offering the plan.

If you see a variety of specialists, you may not be able to find a D-SNP plan that has all of those providers in-network.

FAQs

What's the difference between Medicaid and Medicare?

Medicare is healthcare coverage for people age 65+ or those under 65 with qualifying disabilities and conditions.

Medicaid is healthcare coverage for those with limited financial resources.

Summary

Medicare Dual Special Needs plans are a type of Medicare Advantage plan available only to people who have Medicare and a qualifying level of Medicaid. To see if you qualify for a DSNP, schedule an appointment with The Medicare Family. We’ll walk you through the application process and answer any questions you have about your unique situation.

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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