Many people wonder whether Medicare and Medicaid are one and the same. There’s no question that Medicare and Medicaid are completely different programs, however, it is possible for someone to qualify for both at the same time.
Medicare is a federally subsidized health insurance program designed for US citizens and US residents over the age of 65 and those who qualify for the program based on disability. While Medicare is a federal program and the costs are subsidized for those who worked at least 10 years or 40 quarters in the US, it is not free. There are premiums associated with Medicare that include Part B and Part D, as well as cost sharing fees that are required when you use the program.
Medicaid, on the other hand, is a state funded health insurance program designed for low income and low asset individuals and families who need help paying their health insurance costs. Medicaid generally provides free or very low-cost health care to eligible participants. Since Medicaid is state funded, each state determines its own requirements for eligibility. Some states have expanded Medicaid to include higher income thresholds while others have not. Many states also have the Medicare Savings Program which is a federally funded Medicaid program designed specifically for Medicare beneficiaries.
So how can someone participate in both programs at the same time? An estimated 12.3 million Medicare beneficiaries across the country, which is roughly 20 percent of the Medicare population, are currently enrolled in Medicaid or a Medicaid-funded program. These beneficiaries are considered Dual Eligible Beneficiaries or Medi-Medi Beneficiaries. In most cases, Medicare is the primary payor and Medicaid comes in after to help cover the out-of-pocket costs associated with health care services. Sometimes, Medicaid will even cover Medicare Premiums in addition to helping with the copays and coinsurance. In other instances, Medicaid funds long-term care facility costs or home health services.