Introduction to Medicare
Medicare, Medicaid and Dual Eligibility
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 what are the differences between the two? Check out the charts below to see the side-by-side differences between Medicare and Medicaid.
And what if you have both Medicaid and Medicare? See the "dual eligibility" section below to find out about Dual Special Needs Plans (D-SNPs) for those who have both Medicaid and Medicare.
Medicare vs. Medicaid
What they are:
| Medicare | Medicaid |
|---|---|
|
A joint federal and state program that helps pay health care costs for certain individuals and families with limited income and resources. |
| Medicare |
|
|---|---|
| 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 | Medicaid |
|---|---|
| Federal government | State governments |
| Medicare | Federal government |
|---|---|
| Medicaid | State governments |
What they cover:
| Medicare | Medicaid |
|---|---|
|
Depends on the coverage you choose and may include:
|
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:
|
| Medicare |
Depends on the coverage you choose and may include:
|
|---|---|
| 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:
|
What they cost:
| Medicare | Medicaid |
|---|---|
| It depends on the coverage you choose. Costs may include premiums, deductibles, copays and coinsurance. | It depends on your income and the rules in your state. Costs may include premiums, deductibles, copays and coinsurance. |
| 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 | Medicaid |
|---|---|
| Many people are enrolled in Parts A and B (also known as Original Medicare) automatically when they turn 65. You can also contact your local Social Security office to see if you are eligible based on your individual circumstance. | Eligibility depends on the rules in your state. Call your State Medical Assistance (Medicaid) office to see if you qualify. |
| Medicare | Many people are enrolled in Parts A and B (also known as Original Medicare) automatically when they turn 65. You can also contact your local Social Security office to see if you are eligible based on your individual circumstance. |
|---|---|
| Medicaid | Eligibility depends on the rules in your state. Call your State Medical Assistance (Medicaid) office to see if you qualify. |
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Dual Eligibility
Dual is just another way of saying "two" or "both." "Dual-eligible" describes people who are eligible to receive both Medicare and Medicaid benefits.
- A person qualifies for Medicare due to age or having a disability.
- A person qualifies for Medicaid based on the rules in the state where they live.
To qualify for a D-SNP, you must receive Original Medicare (Parts A and B) and full Medicaid benefits. Depending on the amount of Medicaid benefits you receive, you may be considered a "full dual-eligible" or a "partial dual-eligible." If you receive full Medicaid benefits, you will be fully dual-eligible. Most of the time, individuals who qualify get a letter from their state Medicaid office. You can also call to find out your status.
What is a Dual Special Needs plan (D-SNP)?
There are health plans designed for people who are dual-eligible. They're called Dual Special Needs Plans, or D-SNPs for short. These dual health plans include at least the same coverage as Original Medicare Part A and Part B benefits, as well as Part D prescription drug coverage. But Dual Special Needs Plans go even farther. These plans usually include many extra benefits and features beyond Original Medicare. And for people who are fully dual-eligible, there's no extra cost.
What extra benefits are included?
Dental, vision and hearing coverage, credits to buy health products, plus transportation assistance and more. These are just a handful of examples of the extra benefits Dual Special Needs Plans typically include. Each plan is different, so be sure to look at what's available where you live.
What happens to my Medicaid benefits?
A Dual Special Needs Plan is a type of Medicare Advantage plan. It will replace your current Medicare plan. But a Dual Special Needs Plan doesn't replace your Medicaid plan or change your Medicaid eligibility. You'll keep the same Medicaid plan you have today, and you'll still get all the same Medicaid benefits you get now.
