How to qualify for both Medicare and Medicaid

These programs may sound the same, but they’re different in many ways.

Medicare

Medicare is the United States’ federal health insurance program. There are 4 different parts of Medicare that help cover specific services:

• Medicare Part A (Hospital Insurance): Part A generally helps cover services you receive in a hospital or long-term care setting.
• Medicare Part B (Medical Insurance): Part B covers certain doctors’ services, outpatient care, medical supplies and preventive services.
• Medicare Part C (Medicare Advantage): Part C plans, also called Medicare Advantage (MA), are private insurance plans that provide all of Part A and Part B coverage and typically offer extra benefits such as vision, hearing and dental care. Most also include Medicare Part D drug coverage.²
• Medicare Part D (Prescription Drug Coverage): Part D plans are private insurance plans that help cover the cost of prescription drugs.

Eligibility requirements for Original Medicare Parts A and B include:

• Age 65 or older
• Younger than 65 with a qualifying disability
• Living with end-stage kidney disease (permanent kidney failure requiring dialysis or a kidney transplant)

Medicaid

Medicaid is an assistance program provided jointly by federal and state agencies. It helps with medical expenses for eligible people with limited income and resources. There are different rules for each state, but in most states, you may be eligible for Medicaid if you are under certain income levels and/or are:

• Age 65 and older
• A child under age 19
• Pregnant
• Living with a disability
• A parent or adult caring for a child
• An adult with dependent children
• An eligible immigrant

People who qualify for both Medicare and Medicaid are called “dual eligible.” If you’re dual eligible, your Medicaid and Medicare plan(s) will work together to provide coverage for your needs. In most cases, Medicare will be your primary plan and cover most Medicare-eligible healthcare services. Medicaid is typically the secondary plan and may cover medical costs that Medicare doesn't cover or partially covers.

How do I qualify for dual eligibility?

To qualify for dual eligibility, you must meet the requirements for both Medicare and Medicaid and be enrolled in both programs.

For enrollment information, check out these resources:

• Sign up for Medicare
• Apply for Medicaid coverage by state

Benefits of dual eligibility

Being dual eligible can provide greater healthcare coverage. Medicaid also covers some expenses that Medicare does not, such as long-term nursing home care and personal care services.

Some other potential items and services covered by dual eligibility include:

• Durable medical equipment, like canes, walkers and wheelchairs
• Doctor visits
• Inpatient and outpatient hospital services
• Mental health services
• Prescription drugs
• Preventive care
• Dental services

What are Dual Eligible Special Needs Plans (D-SNPs)?

D-SNPs  are a type of Medicare Advantage plan. They’re offered by private insurance companies approved by Medicare. To be eligible, you must be enrolled in both Medicare and Medicaid. With a D-SNP, all your Medicare and Medicaid benefits are combined into 1 easy-to-manage plan.

All Dual-Eligible Special Needs Plans include Part D prescription drug coverage at no extra cost to you. In addition, you’ll be assigned a care coordinator from your plan provider to develop a care plan to help you achieve your best health.

What is covered by Medicaid and Medicare?

Medicaid plans offer different optional benefits from state to state. However, it’s mandatory for all Medicaid plans to include inpatient and outpatient hospital services, physician services, laboratory and X-ray services and home health services.³

For information on Medicare, check out what Medicare covers (and doesn’t cover).