It is possible for people over the age of 65 or who are disabled to be “dual eligible.” Dual eligible people are divided into two groups:
- Full benefit duals: These people have both Medicare and Medicaid.
- Partial duals: These people have Medicare and Medicaid pays for Medicare premiums and/or cost-sharing.
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 premiums and in some cases your Medicare cost-sharing.
If you are found eligible for the Medicare Savings Program, QMB, it will cover the 20% of costs that Medicare doesn’t not usually pay for a covered service. It will also pay for your Part B premium, and your Part A premium if you don't qualify for free Part A.
For more information about the Medicare Savings Programs and how to apply, visit our Medicare Savings Programs web page.
Help for people with disabilities who are on Medicaid
The Office of the Health Care Advocate (HCA) can help people who have questions about Medicaid. Call us at 1-800-917-7787 or fill out our Help Request Form.