SENIORS

Medicare & Medicaid

How two plans work together to provide complete coverage.

Medicare & Medicaid Programs
The words “Medicare” and “Medicaid” are so much alike that it’s easy to get them confused. Both are government programs and both help people pay for health care. But that’s where the similarities end.

Whereas Medicare beneficiaries typically qualify based on ageIndividuals age 65 and older qualify for Medicare. While individuals who have a disability for 24 months or longer may also qualify., Medicaid beneficiaries qualify based on income.

When individuals have both Medicare and Medicaid, it is often referred to have having dual enrollment.

Benefits of Having Both

Dual plans offer extra benefits at no extra cost.

Dual plans go beyond either Medicaid or Original Medicare alone. You’ll still keep the Medicaid benefits you get today. And better yet, with a dual plan, you could get many extra benefits and features than Original Medicare at no extra cost. These extra benefits may include:

  • Dental care, plus credit for restorative work.
  • Eye exams, plus credit for eyewear.
  • Hearing exams, plus credit for hearing devices.
  • Rides to health care visits and the pharmacy.
  • Credits to buy hundreds of health-related products.

As an added bonus, people who are dual eligible can usually enroll for no monthly premium.

Election Periods

Being Dual eligible allows individuals additional election periods, other than the Initial Election Period (IEP), Annual Election Period (AEP), and the Open Enrollment Period (OEP).

These additional election periods come in the form of being able to enroll or dis-enroll once per calendar quarter, January through September.

What You May Have Now What You Could Have
Medicaid benefits
Hospital Stays
Doctor and outpatient care
Prescription drugs
More choice of doctors
More hospital choices
Additional prescription drug coverage
Additional benefits
* Benefits assuming you qualify for a Dual Special Needs Plan.

Tip

It can be a good idea to review your Medicare Prescription Drug Plan coverage every year, to see if your plan covers the medications you need now and may need in the upcoming year.

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Frequently Asked Questions
What's the difference between Medicaid and Medicare?
Medicare is a national health insurance program run by the federal government. It’s for people age 65 and older, and also some people under age 65 with certain disabilities. Medicaid is a joint program that states and the federal government fund together. Millions of people get health coverage through their state Medicaid program. Children, pregnant women, elderly adults and people with disabilities, as well as eligible low-income adults are typically covered by Medicaid.
What does dual eligible mean?
People who qualify for both Medicare and Medicaid at the same time are “dual eligible.” They are “dual eligible” for both health care programs.
Who can qualify for Medicaid?
All state Medicaid programs cover low-income people who qualify, including families and children, pregnant women, the elderly and people with disabilities. Some state Medicaid programs cover all low-income adults who earn less than a set income level.
How can I enroll in Medicaid?

To apply for Medicaid, you’ll need to submit an application to the agency that manages the Medicaid program in your state. In the state of Texas the first website to reference is: YourTexasBenefits.com, where you can apply online for Medicaid benefits.

What do I need to apply for Medicaid?

When you apply for Medicaid, you’ll need to fill out an application form. Different states have different requirements for Medicaid. You’ll likely need to have various documents, such as:

Personal information

  • Information about household members (name, date of birth, and Social Security number)
  • Proof of citizenship
  • Financial information

Rent or mortgage information

  • Expenses (utilities, daycare, etc.)
  • Vehicle information
  • Bank statements
  • Income (pay stubs)

Medical information

  • Proof of disability or medical records showing a lasting medical condition
  • Recent medical bills

Plans Focused on Preventative

Many of these Medicare Advantage plans have preventative coverage and add-ons that are preventative focused.