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Introduction to Medicare

 

Medicare, Medicaid and Dual Eligibility

 

 

Medicare Education Home

  • Introduction to Medicare
    • Medicare Eligibility
    • Coverage Choices
    • Prescriptions, Providers & Benefits
    • Medicare Cost Basics
    • Medicare, Medicaid and Dual Eligibility
  • Types of UnitedHealthcare Plans
  • Enrollment and FAQ

Medicare and Medicaid
 

The words "Medicare" and "Medicaid" are so much alike that it's easy to get them confused. Both are government programs and both help people pay for health care. But that's where the similarities end. Check out the chart below to see the main differences.

What they are:

Medicare

  • A federal health insurance program for people who are:
  • 65 or older
  • Under 65 with certain disabilities
  • Of any age and have End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig's Disease)

Medicaid

A joint federal and state program that helps pay health care costs for certain individuals and families with limited income and resources.

Who offers them:

Medicare

Federal government

Medicaid

State government

What they cover:

Medicare

Depends on the coverage you choose and may include:
 

  • Care and services received as an inpatient in a hospital or skilled nursing facility (Part A)
  • Doctor visits, care and services received as an outpatient and some preventive care (Part B)
  • Prescription drugs (Part D)

Medicaid

Each state creates its own Medicaid program, but has to follow federal guidelines, like the required and optional benefits they include. Some of the benefits Medicaid programs have to include are:
 

  • Care and services received in a hospital or skilled nursing facility
  • Care and services received in a federally-qualified health center, rural health clinic or freestanding birth center (licensed or recognized by your state)
  • Doctor, nurse midwife, and certified pediatric and family nurse practitioner services

What they cost:

Medicare

It depends on the coverage you choose. Costs may include premiums, deductibles, copays and coinsurance.

Medicaid

It depends on your income and the rules in your state. Costs may include premiums, deductibles, copays and coinsurance.

How to get them:

Medicare

Many people are enrolled in Parts A and B automatically when they turn 65. You can also contact your local Social Security office to see if you are eligible.

Medicaid

Eligibility depends on the rules in your state. Call your State Medical Assistance (Medicaid) office to see if you qualify.

Dual Eligibility
 

Individuals who qualify for both Medicare and Medicaid at the same time are called "dual" or "dual eligible." Dual Special Needs Plans, or DSNPs, are designed specifically for dual-eligible people. DSNPs include at least the same coverage as Original Medicare Part A and Part B benefits, as well as Part D prescription drug coverage in one plan. For people with limited incomes, these plans can offer better health care coverage than Original Medicare and a separate, standalone Part D plan.

 

How do I qualify?

 

To qualify for a DSNP, you must receive Original Medicare (Parts A and B) and full Medicaid benefits. This means Medicaid pays for all or part of your Medicare copayments, coinsurance and deductibles. Most of the time, individuals who qualify get a letter from their state Medicaid office. You can also call them to find out your status.

 

How do they work?

 

Medicaid benefits can help pay for the costs of a DSNP. Plus, DSNPs often provide additional benefits not offered by Medicare, such as routine hearing, vision and dental care, as well as coverage for transportation.

 

How can I find out more?

 

For information about dual-eligible programs, call Social Security toll-free at 1-800-772-1213, TTY 1-800-325-0778, 7 a.m. to 7 p.m. local time, Monday through Friday. Or contact your state Medical Assistance or Medicaid office. 

 

Learn more about Dual Special Needs Plans from UnitedHealthcare  

 

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