The words “Medicare” and “Medicaid” are so much alike that it’s easy to get confused. To add to the confusion, both are government programs that help people pay for health care. But that’s where the similarities end.
See below for more information about each program and how they compare.
What Is Medicare? What Is Medicaid?
Medicare is a federal program generally for people who are 65 or older or have a qualifying disability or medical condition. Medicare Part A and Part B are provided by the federal government, and Medicare Part C and Part D, while federally governed, are provided by private insurance companies.
Medicaid is a state government program that helps pay health care costs for people with limited income and resources, and different programs exist for specific populations. Medicaid plans vary from state-to-state but follow federal guidelines for benefits.
What Do Medicare and Medicaid Cover?
Medicare Part A is hospital insurance and Part B is medical insurance. Medicare Part D is prescription drug coverage, and Part C (Medicare Advantage) is an all-in-one coverage option that combines Parts A, B and D, as well as other benefits that may include items like dental, vision, fitness and hearing. Medicare Part A and Part B coverage is standard, but Part C and Part D will vary based in terms of coverage provided depending on the plan, the insurance provider and your location.
How Much Does Medicaid Cost? How Much Does Medicare Cost?
Both Medicare and Medicaid may include premiums, deductibles, copays and coinsurance. For Medicare, how much you pay will vary based on when you enroll, what coverage options you select and what health services and items you use throughout the year. For Medicaid, the amount you pay depends on your income and the rules in your specific state. Additionally, some specific groups under Medicaid are exempt from many out-of-pocket costs.
There are also four different Medicare Savings Programs, which are designed to help with the cost of Medicare. If you meet the conditions to qualify for one of these programs, you could get help paying for your Medicare premiums, and in some cases, also get help paying Medicare Part A and Part B deductibles, coinsurance and copayments.
Can You Have Both Medicare and Medicaid?
Yes, some people can have both Medicare and Medicaid. People who qualify for both Medicare and Medicaid are called “dual eligible.” If you qualify and choose to enroll in both programs, the two can work together to help cover most of your health care costs. You may also be eligible for a special kind of Medicare Advantage plan called a Dual Special Needs Plan. You can learn more about being dual eligible and how Medicare coverage can work for you here.
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ON SCREEN TEXT: Medicare Conversations Dual Special Needs Plans...
A question appears beside a yellow circle labeled DSNP.
ON SCREEN TEXT:“What is a Dual Special Needs Plan (DSNP)?”
A woman with light brown hair sits in a white chair as she interviews.
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ON SCREEN TEXT: Holly Martin, Dual Special Needs Expert
ON SCREEN TEXT: Medicare Made Clear® by UnitedHealthcare®
HOLLY: Hello, everyone. I'm Holly Martin and over the last several years, I have worked on bringing education and awareness to Dual Special Needs Plans.
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ON SCREEN TEXT: What they are Why they are different Who is eligible
HOLLY: We're going to talk about what Dual Special Needs Plans are; we're going to talk about why they're different —they're a different type of Medicare Advantage plan; and we're going to talk about who's eligible for them; and what to know about whether or not a Dual Special Needs Plan might be right for you or someone you love.
So, let's go ahead and get started.
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ON SCREEN TEXT: “What is dual eligibility?”
HOLLY: So, let's talk a little bit more about what it means to be dual eligible.
Dual eligible simply means that you are both Medicare eligible and Medicaid eligible.
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HOLLY: On the Medicare side, that means that you could’ve reached the magical age of 65 or that you can have a qualifying disability at ages 18 years all the way up to age 64.
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HOLLY: To qualify for Medicaid, it simply means that your income is below the federal poverty level and that level really varies by state.
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ON SCREEN TEXT: “When would I enroll in a DSNP?”
HOLLY: Being dual eligible allows you to enroll at any point in time in the year.
So, you can enroll during the annual enrollment period, or you can enroll in January or in April or whenever it best suits your needs.
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ON SCREEN TEXT: “What does a DSNP entail?”
HOLLY: So, what is a Dual Special Needs Plan? A DSNP plan is just a special kind of Medicare Advantage plan that is there for those who have both Medicare and Medicaid eligibility.
A yellow DSNP circle changes to read Medicare Advantage Plan.
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HOLLY: And that special Medicare Advantage plan takes your Medicare, your Medicaid and your Part D needs, and puts them all together in one package to provide you with an overall health care experience.
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ON SCREEN TEXT: “Are DSNP plans all the same?”
HOLLY: A Dual Special Needs Plan is a Medicare Advantage plan, and just like all Medicare Advantage plans, the costs, the benefits, and the coverage are going to vary based on whoever is providing that plan.
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ON SCREEN TEXT: “How are DSNP plans unique?”
HOLLY: Dual Special Needs Plans are unique in that they provide extra benefits. So, along with providing you your Medicare, your Medicaid and your Part D coverage, they also offer you extra benefits that help you utilize that health care coverage.
Medicare, Medicaid, and Part D plan circles appear, then a circle appears off to the side with a blue medical cross that reads Extra benefits.
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HOLLY: Things like transportation to make sure that you get to your doctor visit safely and on time.
They can also be things like dental or vision coverage or perhaps credits to help you purchase over-the-counter products.
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ON SCREEN TEXT: “Are there costs associated with DSNP plans?”
HOLLY: DSNP plans typically come at no additional cost to you. However, the costs of a DSNP plan are going to depend on your Medicaid eligibility levels.
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HOLLY: So, right now, for example, if you're not paying anything for your Medicare and your Medicaid and your Part D, what's so great about a DSNP plan is that you can join that plan, you won’t lose any of those benefits that you currently have, and you won't pay any more to be a part of a DSNP plan and gain all of the extra benefits we just talked about, as well as that coordination of care.
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ON SCREEN TEXT: “What if I still have questions?”
HOLLY: So, we've learned a little bit about Dual Special Needs Plans today, and if you'd like to learn even more, visit us online.
To get Medicare Part A and Part B, you’ll need to enroll with Social Security directly. The exception to this rule is if you are receiving Social Security or Railroad Retirement Board benefits when you become eligible for Medicare, generally at age 65. In this case, you’ll be automatically enrolled in Medicare Parts A and B. To get Medicare Part C or Part D, you’ll need to enroll directly with the private insurance company providing the plan you want.
How to get Medicaid
Eligibility for Medicaid depends on the rules in your state. To see if you qualify, and to begin enrollment, contact your State Medical Assistance (Medicaid) office. You can visit www.medicaid.gov to find a local office and learn more about Medicaid eligibility and enrollment.
Medicare and Medicaid are two very different health care programs, so it’s important to understand the differences between them, and if you’re dual eligible, how they can work together to your benefit.