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Can You Have Medicare Advantage and Medicaid?

May 26, 20232 min read

Can You Have Medicare Advantage and Medicaid?

Introduction

The healthcare landscape in the United States is complex, with various programs designed to provide coverage for different populations. Two such programs are Medicare Advantage and Medicaid. But can you have both? The answer is yes, in certain cases. This article will delve into the intricacies of these programs, their eligibility criteria, and how they can work together to provide comprehensive healthcare coverage.

Understanding Medicare Advantage and Medicaid

Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare (Part A and Part B). It is offered by private insurance companies approved by Medicare and typically combines hospital, doctor, and prescription drug benefits into a single health insurance policy. On the other hand, Medicaid is a state and federal program that provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

Dual Eligibility: The Intersection of Medicare Advantage and Medicaid

People who qualify for both Medicare and Medicaid are known as "dual eligibles." With both types of coverage, most healthcare costs and expenses are covered, resulting in minimal out-of-pocket costs. The coordination between Medicare Advantage and Medicaid in a dual special needs plan can result in several extra benefits not covered or only partially covered by Medicare. These can include dental benefits, hearing aids, home health services, nursing home care, transportation to and from doctors, and more.

The Benefits of Dual-Eligible Medicare Advantage Plans

Dual-eligible Medicare Advantage plans are specifically designed to work hand in hand with Medicaid. These plans offer several advantages:

  1. More Doctor Choices: With a Medicare Advantage plan, you have access to doctors who work with a Medicare Advantage company, even if they don't accept Medicaid payment.

  2. Extra Benefits: Combining Medicaid with a Medicare Advantage plan can provide additional benefits that Medicaid and Medicare do not provide. These can include vision care, dental benefits, discounts on hearing aids, free gym memberships, and transportation to and from doctors' appointments.

  3. Personalized Help: Enrolling in a Medicare Advantage plan gives you access to a health insurer to guide you as medical needs arise. The health insurance agent who signed you up for Medicare Advantage can provide personal assistance in getting all the benefits to which you are entitled.

  4. Additional Enrollment Opportunities: If you have Medicaid, your signups for Medicare Advantage are not limited to the Annual Election Period (AEP) at the end of each year. Instead, you'll have three additional opportunities evenly spaced throughout the year to enroll.

Conclusion

In conclusion, it is indeed possible to have both Medicare Advantage and Medicaid. The combination of these two programs can provide comprehensive healthcare coverage, with the potential for additional benefits. However, navigating these programs can be complex, and it's recommended to consult with a broker or plan provider to understand all the details and make the most informed decision.

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