It is possible for people over the age of 65 or who are disabled to be “dual eligible” – this means that you are covered by both Medicare and Medicaid.
Medicare is a federal program that provides health insurance to those who qualify to receive Social Security benefits. Many people become eligible for Medicare when they turn 65 years old. However, some people are automatically enrolled in Medicare if they are under 65 years old and have a disability that has been recognized by Social Security for two years.
Medicare has monthly premiums, co-payments and deductibles. Premiums are usually taken out of your Social Security check.
Medicaid is based on need. Medicaid covers more services than Medicare and pays for some services that are not covered by Medicare, such as living in a nursing home. Medicaid can also pay some of your Medicare costs. For example, Medicare usually pays 80% of a covered service. Medicaid can pay the remaining 20% if your doctor accepts both Medicare and Medicaid.
Who Pays First?
Medicare almost always pays first, and Medicaid pays second.
If you are covered by both Medicare and Medicaid, it can be confusing to know which insurance pays first. This booklet from the US Department of Health and Human Services provides helpful information about Who Pays First.
Lowering Your Medicare and Out-of-Pocket Costs
The Medicare Savings Programs (QMB, SLMB, and QI-1) can pay your monthly Medicare Part A and/or B premium.
If you are found eligible for the Medicare Savings Program, QMB, and you don’t qualify for free Medicare Part A insurance, the program will pay your monthly Medicare Part A premium and the 20% of costs that Medicare doesn’t not usually pay for a covered service.
For more information about the Medicare Savings Programs and how to apply, visit our Medicare Savings / Buy In Programs web page.
Help for People with Disabilities Who are on Medicaid
The Office of the Health Care Advocate (HCA) at Vermont Legal Aid can help people with disabilities who have questions about Medicaid. Call the HCA at 1-800-917-7787.
Help for Seniors Who are on Medicaid
The Senior Citizens Law Project (SCLP) of Vermont Legal Aid will help seniors with questions about Medicaid. Call Vermont Legal Aid at 1-800-889-2047. Additional rules may apply to your situation.