Types of Medicaid for people with Medicare

If you are eligible for Medicare Medicare Medicare is the federal government health insurance program that provides health care coverage if you are 65 or older, are under 65 and receive Social Security Disability Insurance (SSDI) for 24 months, begin receiving SSDI due to ALS/Lou Gehrig’s Disease, or have End-Stage Renal Disease (ESRD) no matter your age. You can receive health coverage directly through the federal government (see Original Medicare) or through a private company (see Medicare Advantage). and have a sufficiently low income, you may qualify for help from certain Medicaid Medicaid Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets.  programs in your state. Whether you qualify will depend on:

• Your earned and unearned income unearned income Unearned income is money you get from sources other than current employment. This includes Social Security benefits, Veterans benefits, pensions, annuities, and other regular payments you receive, such as alimony and workers’ compensation. , including wages and Social Security payments
• Your assets, including checking accounts, stocks, and some property
• Your nursing care and long-term care needs
  • You must meet your state’s functional eligibility criteria (standards for assessing your need for help with activities of daily living, such as, toileting, bathing, and dressing). Each state sets its own standards.

Medicaid programs vary by state, but below are three Medicaid programs available to Medicare beneficiaries in all states. Note that in all of these cases, if you have both Medicare and Medicaid, Medicare will pay first for covered services, and Medicaid will pay second for qualifying costs. If you meet income, asset, and other guidelines in your state, you may qualify for one of the following Medicaid programs:

1. Aged, blind, and disabled (ABD) Medicaid: Beneficiaries with ABD Medicaid have coverage for a broad range of health services, including doctors’ visits, hospital care, and medical equipment. ABD Medicaid may also pay for your Medicare cost-sharing cost-sharing Cost-sharing is the portion of medical care costs that you pay yourself, such as a copayment, coinsurance, or deductible, if you have health insurance coverage. See also: Out-of-Pocket Costs. . However, ABD Medicaid may not provide adequate coverage if you have long-term care needs.
2. Medicaid home and community-based service (HCBS) waiver programs: HCBS waiver programs provide general health coverage and coverage for certain services to help you stay at home or in a community-based setting (for example, in an assisted living facility assisted living facility Assisted living facilities are long-term care facilities designed to assist people with activities of daily living who can otherwise take care of themselves. They are different from nursing homes, which also provide skilled care. Medicare does not cover room and board in an assisted living facility. ). Covered services may include personal care personal care Personal care, also known as unskilled care, is assistance with activities of daily living. Providers of personal care (home health aides) are not required to undergo medical training. Medicare only covers personal care if you are homebound and receiving skilled care. , homemaker services, case management, adult day care, skilled nursing care, and therapy services. To qualify, you must meet state-specific functional eligibility criteria.
3. Institutional Medicaid: Beneficiaries enrolled in Medicaid for residents in nursing homes—also called Institutional Medicaid—have coverage for nursing home nursing home A nursing home, also called a long-term care facility, is a residential facility for people with chronic illness or disability. Nursing home services include room and board, nursing care, personal care, and therapy services. A skilled nursing facility (SNF) is a nursing home that provides skilled care, but not all nursing homes are SNFs. Medicare does not cover the cost of nursing homes that are not SNFs. services, including room and board, nursing care, personal care, and therapy services. To qualify, you must require a nursing home level of care or meet state-specific functional eligibility criteria.