How do Medicare and Medicaid work together to cover my health care costs?

Dear Pam, 

If you are eligible for both Medicare and Medicaid, Medicaid can help with Medicare cost sharing, and having Medicaid can also automatically qualify you for other programs that can reduce your premiums and prescription drug costs. Below are some of the ways Medicaid can work with Medicare. 

• Medicaid can provide secondary insurance: For services covered by Medicare and Medicaid (such as doctors’ visits, hospital care, home care, and skilled nursing facility care), Medicare is the primary payer. When you visit a provider or facility that takes both forms of insurance, Medicare will pay first and Medicaid may cover your Medicare cost-sharing, including coinsurances and copays. Medicaid is the primary payer for services that Medicare does not cover, like durable medical equipment that is needed only outside of your home.  

Note: It is important to review Medicare Advantage supplemental benefits carefully, as they may duplicate coverage you already have from Medicaid and coordination of coverage for these services can be complicated. 

• Medicaid can provide access to premium assistance: In many cases, if you have Medicare and Medicaid, you will automatically be enrolled in a Medicare Savings Program (MSP). All MSPs pay your Medicare Part B premium, and if you are eligible for the Qualified Medicare Beneficiary (QMB) MSP, it will cover the Part A premium and eliminate Medicare cost sharing.  
• Medicaid can provide prescription drug assistance: Medicare beneficiaries who have Medicaid are automatically enrolled in the Extra Help program to help with their prescription drug costs. 
• Medicaid can offer care coordination: Some states require certain Medicaid beneficiaries to enroll in Medicaid private health plans, also known as Medicaid Managed Care (MMC) plans. These plans may offer optional enrollment into a Medicare Advantage Plan designed to better coordinate Medicare and Medicaid benefits.  

You can call 1-800-MEDICARE or contact your local Medicaid office to learn more about how Medicare and Medicaid work together in your state. 

Hope this answers your question! 

-Marci