Medicare & Medicaid are both government run health care programs, with Medicare being run by the federal government and Medicaid being run by both federal and state governments. Medicare is available for US citizens and permanent residents over age 65, and some persons with disabilities under age 65. Medicaid benefits are available to people with limited income and limited assets who otherwise would not be able too afford health care.
When a person is eligible for both programs, this is called dual eligibility. According to Medicare.gov, approximately 12 million US residents are dually eligible and enrolled in both programs.
Medicare Part A – pays for inpatient hospital costs. Most people do not have to pay a monthly premium for Part A coverage
Medicare Part B – pays for outpatient services like doctor visits, labs and x-rays, and durable medical equipment. Most enrollees have their Part B premiums deducted from their social security payments
Medicare Part C – is a private health insurance alternative to Original Medicare. Enrollees must have Part A and Part B Medicare coverage, but are also offered extra services like dental, vision, and hearing care. Part C Plans are also known as Medicare Advantage plans
Medicare Part D – provides prescription drug coverage
Like private insurance plans, Medicare has deductibles, coinsurance, and copayments for certain services. Medicare often covers part-time home health care and hospital stays, but does not cover nursing home care in a skilled nursing facility beyond the first 100 days.
Dual eligible special needs plans (D-SNPs) are a specialized type of Medicare Advantage plan that are only available for those enrolled in both a Medicare plan and a Medicaid plan. Qualifying individuals will receive low or no-cost care. Plans vary widely by county and state, with some states offering no D-SNPs. D-SNPs are managed by private insurance companies, not the federal government.
Each state Medicaid program will differ in its benefits, but Medicaid coverage usually offers benefits that Medicare does not, such as care in a skilled nursing facility and personal care services. Medicaid eligibility is limited to those with low income and limited resources. Users of Medicaid’s health care services usually do not have to pay anything for their care, although occasionally there will be an out-of-pocket cost for certain items or services.
When person has both Medicare and full Medicaid, Medicare will be considered their medical insurance. This means that Medicare covers costs first, with Medicaid picking up any remainder. In some cases, Medicaid will even pay Medicare premiums through Medicare Savings Programs.