Not sure if Medicare or Medicaid is right for you? They’re both government health care programs. You could be eligible for one or both. Let’s take a look at the differences between Medicare and Medicaid and how they can work together for better coverage.
The difference between Medicare and Medicaid
Medicare and Medicaid are often grouped together. But these programs are quite different. Both provide health insurance benefits, but eligibility and coverage vary.
What is Medicare?
Medicare is a federal program available to people 65 years and older or people under age 65 with certain disabilities. It helps enrollees pay for the cost of health care. This includes hospital costs (Part A) and medical costs (Part B). Those eligible can purchase additional coverage from a private insurance plan. To get coverage for outpatient prescription drugs, you need to purchase a Medicare Part D plan from a private insurer.
What is Medicaid?
Medicaid is a federal and state program that provides free or low-cost coverage to low-income individuals or families. Unlike Medicare, eligibility is based on yearly income instead of age or disability status. It also helps pay for health care, home and community-based services, and nursing home care. In Minnesota, the Medicaid program is called Medical Assistance.
What does dual eligible Medicare and Medicaid mean?
While Medicare and Medicaid are different, they can also work together. For those who are age 65+ and eligible, it’s possible to have Medicare and Medicaid at the same time – this is known as a Dual Eligible Special Needs Plan (D-SNP).
This type of dual plan offers elements of both insurance options. It combines medical, hospital, prescription drug coverage and more. A dual Medicare and Medicaid plan helps low-income enrollees older than 65 get care and the services of both programs. In Minnesota, the plan name for dual eligible enrollees is Minnesota Senior Health Options (MSHO).
Better together: Key benefits of dual Medicare and Medicaid plans
Getting your Medicare and Medicaid services in one plan is convenient and affordable. A dual plan has no monthly premium. It also helps you get the coverage you need.
For instance, Original Medicare doesn’t cover the cost of long-term and personal care facilities. Some Medicaid policies do. A dual plan will help make sure you’re covered. It also includes Medicare Part D prescription drug coverage and dental.
But not all dual Medicare and Medicaid plans are the same. Some have “supplemental benefits” – extras to help you stay healthy. This might include fitness programs, meal delivery and more. When you’re looking for a dual plan, always make sure to check the full list of benefits. This way you can choose the best plan for you.
Personal support is part of a dual plan
So, how does a dual plan work in practice? With many MSHO plans, you’ll choose a primary doctor to manage your care. Your doctor can also refer you to a specialist or get health plan approval for specific types of care.
This type of plan will have a network of doctors, clinics and hospitals. Check the provider list to make sure you get your care in-network. You may have to pay for services you get out of the network (except for emergencies, out-of-area urgently needed care or renal dialysis). For home and community-based services, MSHO plans use every provider that is enrolled with the state.
You’ll also have a care coordinator to guide your health care. This person is usually a registered nurse or a licensed social worker. Here’s the type of personal support work a care coordinator does:
- Explains how your plan works
- Partners with you to understand your key health goals and collaborates with you to create a person-centered care plan; then gives you support and tools to reach those goals
- Helps you refill prescriptions as needed
- Helps you navigate Medicare and Medicaid services you may be eligible for like home health care, personal care assistance, homemaker and companion services, delivered meals or home safety equipment
How do I qualify for Medicare and Medicaid?
Interested in getting a Medicare or Medicaid plan? Checking your eligibility can be simple – like a quick phone call or visiting a website. Here’s how you can get started.
Medicare: You’re eligible for Medicare three months before you turn 65 or if you have a disability, amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD). You can get an eligibility estimate or talk with a Medicare support team member through www.medicare.gov.
Medicaid: Eligibility for Medicaid depends on which state you live in and your current financial situation. For more information about seniors’ eligibility in Minnesota, head to the Minnesota Department of Human Services website.
How to enroll in an MSHO plan
If you think you’re eligible for an MSHO plan, you can get the information you need from the following sources:
- The Minnesota Department of Human Services website or at 800-657-3739
- Your State Health Insurance Assistance Program (SHIP); the Senior LinkAge Line® is the SHIP in Minnesota and offers free, independent health plan consulting at 800-333-2433, TTY 711, 8 a.m. to 4:30 p.m. Monday through Friday
- Your County Human Services office
- The sales team at an insurance company that offers MSHO plans
Have more MSHO questions?
Our experts are here to help you find the best Medicare plan for the way you live. Learn more about Minnesota Senior Health Options.