Medicare and Medicaid — Understanding Help With Healthcare Costs
Medicare and Medicaid are different programs, and some people may qualify for both. There are also programs that can help eligible Medicare beneficiaries with certain Medicare premiums, cost sharing or prescription drug costs. Understanding which program applies to your situation is the first step.
1. Understand the Programs
Medicare is a federal health insurance program generally available to people age 65 or older and certain younger people who qualify. Medicaid is a joint federal and state program for eligible people who meet their state's requirements. Because the programs serve different purposes, eligibility for one does not automatically mean eligibility for the other.
2. Understand the Types of Assistance
For people with Medicare and limited income and resources, assistance may be available through Medicaid, a Medicare Savings Program, or Medicare's Extra Help program for prescription drug costs. These programs have different eligibility rules and provide different types of assistance.
3. Find Your Next Direction
Start by identifying what help you need. Are you trying to reduce Medicare premiums or other Medicare costs? Do you need help with prescription drug expenses? Are you trying to determine whether you qualify for Medicaid? Once the need is clear, it becomes easier to identify which program and application process to investigate.
Things Worth Knowing
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Medicare and Medicaid are separate programs. Medicare eligibility generally is not based on income, while Medicaid eligibility depends on state rules and individual circumstances.
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Some people qualify for both Medicare and Medicaid. This is commonly referred to as being “dually eligible.”
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Medicare Savings Programs (MSPs) can help eligible Medicare beneficiaries with certain Medicare costs. The amount and type of assistance depend on the program for which the person qualifies.
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Extra Help, also known as the Part D Low-Income Subsidy (LIS), helps eligible people with Medicare prescription drug costs.
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Eligibility limits and program rules can change. Current requirements should be verified with Medicare, Social Security and the appropriate state Medicaid agency.
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Receiving assistance can affect the Medicare coverage choices available to someone and may provide certain enrollment opportunities, depending on the person's circumstances.
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Keep important notices and eligibility documents. They can help you understand which assistance program you have and when eligibility may need to be reviewed.