I volunteer with a community program that helps older people with their daily living activities so they can stay in their homes. We have great conversations when we’re together. Sometimes we share funny stories and other times we talk about important topics. Several people have asked me if there’s a way to get help paying for health care. It’s a great question, and yes, there are options.
Your finances can change at any time, for many reasons. Medicare and Medicaid are federal and state programs that can help. They pay for health care and prescription drug costs if you qualify.
What’s the difference between Medicare and Medicaid?
Medicare is a federal health insurance program. It’s for people who are age 65 or older, certain people under the age of 65 with disabilities, or people with End-Stage Renal Disease. The program has coverage for hospital stays, doctor visits, outpatient care and supplies.
Medicaid is a federal and state health insurance program. It helps pay for health care for children and adults. People qualify for Medicaid based on income or other factors like household size, disability or family status.
Programs that can help with health care costs
Many people don’t know you can have Medicare and Medicaid at the same time. This means you are “dual eligible.” A person enrolled in Medicare can also apply for Medicaid coverage. If you qualify, different Medicaid programs or special health plans can help pay for Medicare premiums, deductibles, copays and/or coinsurance. Medicaid also may cover services Original Medicare doesn’t. For example, Medicaid can cover care in a designated nursing facility if you don’t have money, assets or long-term care insurance to pay for it. In 2016, Medicaid covered costs for 62 percent of all U.S. nursing home residents.
Here are some programs that can provide financial help for health care. Your income and assets determine if you are eligible. Assets include cash, savings and investment and vacation property.
- Help paying for Medicare: There are four different Medicare Savings Programs that help pay for Original Medicare costs. You may qualify based on your income, assets and whether you’re disabled; these guidelines can vary by state. If you qualify, your state may help pay for all your Medicare Part A and/or B premiums. And if you meet certain conditions, your state may also help pay for Medicare deductibles, coinsurance and copayments.
- Help paying for home health costs: The Elderly Waiver Program supports you if you want to keep living in your home but need nursing home-level care. The federal Medicaid waiver program varies by state and typically covers home and community services like home health aides, home delivered meals and homemaker services.
- Help paying for prescription drugs: Original Medicare doesn’t cover outpatient prescription drugs. To get prescription drug coverage, you have to enroll in a separate Medicare Part D Prescription Drug Plan. If you meet certain income and asset limits, you may qualify for Medicare’s Extra Help program to help pay for Medicare prescription drug costs, such as premiums, deductibles, copays or coinsurance.
Some states have health plans that cover both Medicare and Medicaid and are at no or low cost. Medicare Dual Special Needs Plans (D-SNPs) are an option in some states, including Iowa, Minnesota, and Wisconsin. These plans are different than the Medicare Savings Programs we talked about above. In these Dual Special Needs Plans, private health insurance companies provide Medicare and Medicaid benefits for medical, dental and prescription drug coverage in one health care plan plus extra benefits – often at no cost.
- In Minnesota, the Minnesota Senior Health Options (MSHO) program is a Special Needs Plan for people age 65 or older who are eligible for Medicaid and enrolled in Medicare Parts A and B. MSHO plan choices vary by county.
Related content: How to have Medicare and Medicaid at the same time
Resources for state Medicaid programs
Visit your state’s Medicaid website or healthcare.gov for more information. States offer different types of Medicaid benefits, and you’ll need to fill out an application to see if you qualify.
You can find information about your state’s program at the following websites:
- Illinois Department of Health Care and Family Services
- Iowa Department of Human Services
- Minnesota Department of Human Services
- North Dakota Department of Human Services
- South Dakota Department of Social Services
- Wisconsin Department of Health Services
Remember that you have to take action to have these programs. Enroll in Medicare when you’re eligible. And if you have financial limitations, apply for Medicaid. There’s peace of mind knowing that Medicare and Medicaid work together to provide health care benefits and financial help if you qualify.