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How Medicaid Works as Secondary Insurance

Learn how Medicaid works as secondary insurance to coordinate with other health insurance coverage options, including Medicare, marketplace insurance plans and employer-provided health insurance.

Medicaid provides health insurance coverage for more than 72 million Americans. But it’s not the only type of health coverage many of these people have. 

Medicaid can work as both a primary or secondary insurer. In this Medicaid review, we explore when and how the program works as secondary, or supplemental, insurance that can coordinate with other types of insurance. 

Can you have Medicaid and another insurance at the same time?

Some people are eligible for both Medicare and Medicaid and can be enrolled in both programs at the same time. These beneficiaries are described as being “dual eligible.”

For services covered by both Medicare and Medicaid, Medicare pays first and Medicaid serves as the secondary payer. That means Medicare will pick up the bill first and pay its share before handing it off to Medicaid. Copayments and coinsurances that are left remaining after Medicare applies its coverage will be picked up by Medicaid.

Dual-eligible beneficiaries can expect to pay little to nothing out of their own pocket after Medicaid has picked up its share of the cost.

There are also some additional ways in which Medicaid beneficiaries can save money on care with Medicare’s help. 

  • Dual-eligible beneficiaries are often automatically enrolled in a Medicare Savings Program (MSP), which covers the Medicare Part B premium and may offer additional services.

  • Dual-eligible beneficiaries also generally receive Extra Help, which provides assistance with Medicare Part D drug costs.

  • There are certain types of Medicare Advantage plans known as Dual-eligible Special Needs Plans (D-SNP) that are custom built to accommodate the specific needs of those on both Medicare and Medicaid. 

How does Medicaid coordinate with other insurance?

Medicaid acts as the “payer of last resort” when a beneficiary has an employer-based or other private commercial insurance plan. This means Medicaid will be the last plan to contribute to a medical bill and may pick up copayments and coinsurances in similar fashion to how Medicaid works with Medicare. 

Third party liability

Under federal law, all other sources of health care coverage must pay claims first before Medicaid will pick up any share of the cost of care. This is referred to as “third party liability” (TPL), which means the primary payment for care is the responsibility of any available third-party resources and not that of Medicaid.

Some of the coverage types that may be ordered to pay for care before Medicaid include:

  • Group health plans
  • Self-insured plans
  • Managed care organizations
  • Pharmacy benefit managers
  • Medicare
  • Court-ordered health coverage
  • Settlements from a liability insurer
  • Workers’ compensation
  • Long-term care insurance
  • Other state and federal health insurance programs not excluded by law

If you have any questions about how your Medicaid coverage will work with any other existing benefits, contact your state Medicaid program.

Find Medicare-Medicare Plans

If you have Medicaid and are eligible for or enrolled in Medicare, you may be able to find Medicare Dual-eligible Special Needs Plans in your area that can cover many of your health care costs, including prescription drugs. Learn more today by compare available plans online, or call to speak with a licensed insurance agent.

Find Medicare-Medicaid plans where you live.

Speak with a licensed insurance agent

1-800-557-6059

Christian

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.

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