Who Is Eligible for Both Medicare and Medicaid
NPR reports that over 12 million people in the U.S. are dual eligible beneficiaries, meaning individuals qualify for both Medicare and Medicaid.
Medicare is a health insurance program for people age 65 or older or with certain disabilities. Medicaid helps people with low income or limited resources get health coverage. You may wonder who is eligible for both Medicare and Medicaid.
Certain groups of people can qualify for both programs. Knowing if you or your loved one belong to one of these groups can be essential.
Low-Income Seniors (65+)
Seniors aged 65 and older may qualify for both Medicare and Medicaid if they meet certain income requirements. Medicare provides health insurance for this group, but if their income is low, they can also get Medicaid to help with extra healthcare costs. Medicaid can cover things Medicare doesn’t, such as:
- Long-term care
- Some prescription drugs
- Eye exams and glasses
- Dental care
- Hearing aids and exams
If you’re turning 65 soon and want to know if you qualify for both Medicare and Medicaid, consult Midwest Health Insurance Solutions. We are a trustworthy Medicare broker in Omaha, Nebraska. We can help you explore your options and maximize benefits.
Younger Adults With Disabilities
Younger adults with disabilities often face financial challenges, especially with healthcare costs. Most qualify for Medicare due to their disability. Medicare covers basic healthcare needs, but it doesn’t cover everything.
Some individuals may also qualify for Medicaid if their income is low. Medicaid assists in paying for things that Medicare does not cover, such as dental care and long-term services. If they qualify for both programs, they can have Medicare and Medicaid dual eligibility.
This provides them with more coverage and helps reduce healthcare costs. With both programs, they get access to a wider range of services and better support for their healthcare needs.
Individuals with End-Stage Renal Disease (ESRD)
People with End-Stage Renal Disease (ESRD), which is kidney failure requiring dialysis, can qualify for both Medicare and Medicaid. Medicare covers dialysis treatments and kidney transplants. However, Medicaid can help cover additional costs, including:
- Transportation to treatment
- Certain drugs not covered by Medicare
- Co-pays and deductibles
- Home healthcare services
- Medical supplies and equipment
If you qualify for Medicare benefits, Medicaid can make it easier to manage the extra costs of ESRD. These benefits can help reduce financial strain and provide more comprehensive care options for individuals undergoing treatment.
People With ALS (Lou Gehrig’s Disease)
People with ALS, also called Lou Gehrig’s Disease, get Medicare right after their diagnosis. If their income is low, they may also get Medicaid.
Medicaid can help with long-term care and other healthcare needs. The support makes it easier to manage daily care and treatment.
For more details about these programs, consider consulting a Medicare counselor. They can explain the programs, assist you with the application process, and clarify Medicaid eligibility criteria.
They can also guide you on how to get the most from your benefits. You don’t have to figure it out alone.
Supplemental Security Income (SSI) Recipients
People who get Supplemental Security Income (SSI) often qualify for both Medicare and Medicaid. SSI provides financial help to low-income individuals who are:
- Elderly
- Blind
- Disabled
- Unable to work due to health
Most SSI recipients receive Medicaid immediately, and after two years, they are also enrolled in Medicare. Having both programs helps cover more medical costs.
It’s an important step in healthcare benefits eligibility. If you or someone you know gets SSI, check if they also qualify for both Medicare and Medicaid. These benefits can provide much-needed support.
Nursing Home Residents
Nursing home residents with low income may get both Medicare and Medicaid. Medicare covers short stays in skilled nursing care. Medicaid covers long-term stays and more services, like help with daily tasks.
If you reside in a nursing home, talk to a healthcare expert. They can explain what coverage you may get. They look at your income and health needs.
An expert can help you apply and avoid mistakes. They ensure that you receive the care you need. Having both programs can bring peace of mind and better support for long-term care needs in nursing homes.
Home and Community-Based Services (HCBS) Waiver Participants
Some individuals require assistance with daily care but prefer to remain at home. They may qualify for Medicaid through the Home and Community-Based Services (HCBS) waiver.
The waiver helps people get care at home or in the community. It offers support like:
- Home care
- Meal services
- Adult day care
- Transportation to medical visits
- Help with bathing and dressing
- Home safety modifications
Many people on this waiver also have Medicare. Having both programs helps cover more care costs.
This combination offers greater freedom and support. It lets you avoid moving to a nursing home. If you wish to stay home while receiving care, inquire about the HCBS waiver and how it functions.
Low-Income Individuals Receiving State Buy-In
Some states offer help to low-income people through a program called “State Buy-In.” The program helps pay for Medicare costs. If applicable, you might also receive Medicaid.
Medicaid can cover your Medicare premiums. It may also help with co-pays and other costs. Medicare gives you access to doctors, hospital care, and more.
Together, these programs provide robust support for your healthcare needs. You pay less out of pocket and still get the care you need.
If you have a low income, verify if your state provides this program. This can significantly affect your healthcare costs and coverage.
Are You or a Loved One Eligible for Both Medicare and Medicaid? Consult an Expert to Know
Wondering who is eligible for both Medicare and Medicaid? The answer depends on income, age, and health needs.
You may qualify if you are a low-income senior, have a disability, or need long-term care. Some people qualify through SSI, HCBS waivers, or state help programs.
At Midwest Health Insurance Solutions, we can guide you. Our bilingual agent, Edwin Garcia, has over six years of experience. He can help you find the right plan at the right price.
We listen, explain, and make the process easy. Call us today at (402) 972-0820 for trusted help in English or Spanish.
