Are you 65 now (happy birthday!), or will you be soon? If yes, you’ve probably had retirement on your mind, but don’t forget to leave a smidgeon of room for some thought about Medicare and Medicaid. It might be you! It’s one of the benefits for seniors over 65. You’ve probably heard of the programs before—the medical insurance program for people age 65+ and the state-run financial assistance program. Below we’ll briefly discuss the differences between these two programs and how you might be eligible for both. That’s right. Both.

What is the difference between Medicare and Medicaid?

One of the most obvious differences between Medicare and Medicaid services has to do with management. Medicare is a program that is run and managed on a federal level, whereas Medicaid is managed by each individual state government, following some national federal guidelines. 

Though both programs provide health coverage, Medicare coverage is specifically for anyone aged 65 or older, as well as a few people under the age of 65 with certain disabilities or conditions. In addition, it has no income limits. The Medicaid program, however, is a needs-based program that provides health coverage for low-income or low-resource individuals and families. To qualify for Medicaid benefits, you have to prove that you are in need.

What is the difference between Medicare and Medicaid for people with disabilities?

If you are disabled and under the age of 65, you can qualify for Medicare only after you’ve been receiving Social Security Disability Insurance benefits from the Social Security Administration for at least a year. If you are disabled and want to join Medicaid enrollees, you’ll need to apply through the agency that handles your state’s applications. You’ll need to provide proof of income and assets, after which your application will be reviewed. 

What are the eligibility criteria for Medicare and Medicaid?

Determining who is eligible for Medicare and Medicaid can be a bit complicated, but below, we’ve tried to list it out in the simplest way possible. Don’t hesitate to ask for help if you need it. 

Medicare: Meet one or more of the following conditions.

• Be 65+ years old 
• Received SSDI benefits for at least a year
• Have end-stage renal disease (ESRD)
• Have ALS (also called Lou Gehrig’s disease)

Medicaid: 

• Beneficiaries must live in the state through which Medicaid is offered (ex., You have to live in Texas to meet Medicaid eligibility in Texas)
• Be at or below an income and asset limit.

AND/OR

• Can be part of a separate government program (SSI or the breast and cervical cancer treatment and prevention program)
• Be a young adult that’s a former foster care recipient

Be sure to look at your state’s eligibility requirements for Medicaid since income and asset limits differ in every state.

How can I apply for both Medicare and Medicaid?

If you think you qualify for dual eligibility or qualify to receive both Medicare and Medicaid coverage, then you’ll need to apply to both separately. First, the Medicare application can be accessed here. Then, you can either contact the state agency that handles Medicaid in your state to start an application or fill out an application through the Health Insurance Marketplace.

What documents must I provide to apply for Medicare and Medicaid?

Medicare

• Identification. Birth certificate, proof of citizenship (naturalization certificate, a certificate of citizenship, or a U.S. consular report of birth), or legal residency (green card, your admission-departure record) if applicable.
• Military service before 1961. Record of your service (discharge papers).
• Proof of Income. W-2 from the previous year, self-employment tax information from the previous year, and record of social security earnings (social security statement).

Medicaid: provide as many of the following as you have.

• Identification. Birth certificate, proof of citizenship (naturalization certificate, a certificate of citizenship, or a U.S. consular report of birth), or legal residency (green card, your admission-departure record) if applicable.
• Proof of income. A copy of any pay stubs, Social Security statements, and/or pension checks; income tax returns for the past five years; and verification of any other sources of income, for example, rental income or dividends. 
• Bank records. Copies of bank statements for the past five years. 
• Property. A copy of the deed to any property owned within the past five years and a copy of the most recent property tax bill. 
• Retirement accounts. Statements for the past five years of retirement accounts. 
• Insurance. Copies of any insurance policies, including health, life, and/or long-term care insurance.
• Car registration. Registration information for any cars owned by you. 
• Burial arrangements. Copies of any prepaid funeral contracts or deeds to burial plots.

What are the benefits of having both Medicare and Medicaid?

If you have both Medicare (federal health insurance) and Medicaid (needs-based assistance), plan on paying little to nothing for your health care. You may also receive help with necessities like in-home care, assisted living, or long term care facilities. If one program doesn’t cover an expense, the other one probably will. In terms of medical needs, Medicare supplement insurance will always be billed first, and anything not covered will then be paid through the Medicaid program(as long as it’s considered a qualified expense).

FAQ

Can I enroll in Medicare and Medicaid with a pre-existing medical condition?

Yes. Medicaid and Medicare both allow people to enroll in the program regardless of their current or previous health conditions. Down the line, those who are eligible for Medicare part A and B (also known as Original Medicare) might be interested in purchasing a Medicare Advantage Plan, also known as a gap policy, or a policy that helps cover costs that slip through Medicare’s cracks. Medicare and Medicaid do not consider pre-existing conditions when a person applies for coverage. Still, gap insurance policies often do, which may prove to be a barrier to getting a gap coverage policy.

What is the role of Medicare and Medicaid in covering prescription drugs?

Medicare is broken up into four parts: A, B, C, and D. Medicare part D helps cover portions or the entire cost of any prescription drug, though it’s common under Medicare to at least have a copay. Qualifying for Medicaid coverage in full means the entire cost of the prescription drug will be covered. Partial Medicaid coverage helps people set up a Medicare Savings Program (MSP), which helps cover the costs that Medicare doesn’t cover, such as premiums and copays.

Do Medicaid and Medicare work for end-of-life care?

Medicare covers little to no end-of-life care, but Medicaid supports limited at-home care, assisted living, and nursing home care. If you or a loved one is already a part of Medicare and needs end-of-life care, consider applying for Medicaid.