In 2019, there were over 61 million Americans enrolled in Medicare. Close to 20% of these people were eligible for Medicaid as well. Even though Medicare and Medicaid sound very similar, they both function very differently. Qualifying for both means you are Medicare Dual Eligible. Being Medicare Dual Eligible is a great thing and can save you thousands of dollars each year. Both programs work together to help save you money when going to the doctor or getting prescriptions.
Qualifying for Medicare
Did you know that you do not need to be 65 years old to qualify for Medicare? People with certain disabilities can qualify for Medicare Part A and Part B before 65. After receiving Social Security Disability Income for 24 months, you should qualify for Medicare regardless your age.
If you do not have a disability, you will qualify for Medicare Part A and Part B when you turn 65. There are a handful of other requirements, like paying taxes for at least 40 quarters. To learn more about these requirements, please click here.
Your eligibility date is always on the 1st of the month:
- If you were born on the 1st day of the calendar month, your Part A and Part B eligibility date will be on the 1st day of the month prior to your 65th birthday.
- If your birthday is mid month, you will qualify for Medicare Part A and Part B on the 1st day of your 65th birthday month.
To see if you qualify for Medicare, you need to contact the Social Security Administration. The federal government will help you enroll in Part A and Part B of Medicare.
Qualifying for Medicaid
Unlike Medicare, Medicaid eligibility is determined by the State you live in. Each state has different eligibility requirements. Here in Nevada, the Division of Welfare and Supportive Services assists people with Medicaid. People who qualify for Medicaid have low incomes, low savings, and not many assets. There are many questions that go into Medicaid eligibility so it will be best to locate a local Division of Welfare office and talk to someone. Fortunately, you can qualify for Medicaid at any time of year if your income and assets are within the State’s guidelines.
What Does Dual Eligibility Mean?
When you are enrolled in both Medicaid and Medicare, you are Medicare Dual Eligible. Medicare is the primary payer. Medicaid is the secondary payer. With both, your out of pocket costs will be much lower compared to people who only have Medicare. There are different levels of eligibility when Medicare Dual Eligible:
- Qualified Medicare Beneficiary (“QMB”) Program: This program helps pay for Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments.
- Specified Low-Income Medicare Beneficiary (“SLMB”) Program: This program helps pay for Medicare Part B premiums.
- Qualifying Individual (“QI”) Program: Like the SLMB Program, this helps pay for Medicare Part B premiums.
- Qualifying Disabled Working Individual (“QDWI”): This program helps pay for Medicare Part A premiums.
- Full Benefit Dual Eligible (“FBDE”): This program helps pay Medicare cost sharing if the service is covered by both Medicare and Medicaid.
All five programs have different eligibility requirements. Please contact the Division of Welfare and Supportive Services in Nevada to see what you qualify for.
There are other programs like CHIP, Extra Help, PACE, and Dual-Eligible Special Needs Plans. To learn more about these programs, please give us a call.
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When you are Dual Eligible, you have special enrollment rules for Medicare Advantage Plans. Medicare Advantage Plans are offered through private insurance companies and cover medical benefits and usually prescriptions. These health insurance plans may also include added coverages like hearing aids, dental, vision, gym memberships and much more! If you are Dual Eligible, you have different enrollment rules and can change plans or enroll in coverage during the first three quarters of the year. If this sounds confusing, not a problem! We are here to help! Our brokers do not charge fees and we can help you understand your options so you can save money today!
