Introduction to Medicare
Medicare, Medicaid and Dual Eligibility
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 | 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 automatically when they turn 65. You can also contact your local Social Security office to see if you are eligible. | 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 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. |
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Dual Eligibility
People who qualify for both Medicare and Medicaid at the same time are called "dual" or "dual eligible." The plans designed with these needs in mind are called Dual Special Needs plans, or DSNPs. These plans include all Medicare Part A (hospital stay) and Part B (doctor visit) benefits as well as Part D (prescription drug coverage). For people with limited incomes, these plans may offer better health care coverage than Original Medicare and a separate Part D plan.
How do I qualify?
To qualify for a DSNP, you must receive 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 commonly, people who qualify should 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 cover benefits not offered by Original Medicare, such as routine hearing, vision and dental benefits, as well as providing coverage for transportation.
How can I find out more?
For information about dual eligible programs, you can 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.
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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 (doctor visit) 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 Original 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.
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