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Medicare Advantage and Medicaid

Understanding Medicaid and Medicare

Medicaid and Medicare are two different government programs that provide healthcare benefits to qualifying individuals. Medicare is a federal program, while Medicaid is managed jointly by the federal government and individual state governments.

Whether you’re eligible for Medicare, Medicaid, or both depends on several factors, including your age, income and disability status. 

  • Medicare is typically available to people who are 65 years or older or to people who are younger than 65 and have a qualifying disability or medical condition.
  • Medicaid is typically available to low income families, qualifying pregnant women and children, and individuals receiving Supplemental Security Income (SSI). 

Some people are dual eligible, meaning they qualify for both Medicaid and Medicare. In this case, Medicaid may help cover some of the items that Medicare excludes, such as prescription drugs, and may help cover some of your Medicare out-of-pocket costs such as: 

  • Medicare Part B premium
  • Copayments and coinsurance
  • Deductibles

Medicare Advantage and Medicaid

Some Medicare beneficiaries have the option to enroll in Medicare Advantage, which replaces their Part A and Part B benefits with a private insurance plan.

By law, every Medicare Advantage plan must provide at least the same benefits as Medicare Part A and Part B, but many offer additional benefits that Original Medicare (Part A and Part B) doesn't cover.

Some people are dual eligible for Medicare Advantage and Medicaid. If you’re enrolled in a Medicare Advantage plan that provides coverage for a treatment, service, or prescription drugs, your Medicare Advantage plan will cover it rather than Medicaid. 

Medicaid may also cover your Medicare Advantage premium if you have one. The options for dual eligible individuals to receive their Medicare and Medicaid benefits vary by state.

Speak with a licensed insurance agent

A licensed insurance agent can help you better understand your Medicare options and how they work with Medicaid. Speak with a licensed insurance agent today.

*You must continue to pay your Medicare Part B premium. $0 premium plans may not be available in all areas.