How to Qualify for Both Medicare and Medicaid

“In this world nothing can be said to be certain, except death and taxes.” Had Ben Franklin been alive to see the current healthcare situation in our country today, he may have added confusion regarding government healthcare policy as another certainty. It seems there are so many gray areas and variables to consider.

Trying to get a real person on the phone who can give you a straight yes or no answer sometimes seems like a quaint memory from years past. I would like to touch on the differences between Medicare and Medicaid to try to eliminate some of that confusion.

The simplest distinction between the two is that Medicare is generally for people turning 65 and that Medicaid is for folks who need assistance due to financial constraints. However there are areas where the two overlap. Let’s take a look at exactly who qualifies for assistance and what benefits they may be afforded.

When determining eligibility, the Social Security Administration (SSA) will take into account income and resources. There are different levels of assistance for different levels of income and resources.

Confused? Talking to a broker can help clear things up!

Qualified Medicare Beneficiaries (QMB)

Individual monthly income < $1,010 Married monthly income < $1,355
Individual resources < $7,280 Married resources < $10.930

People at this level will receive assistance with part A premiums, part B premiums, as well as deductibles, coinsurance and copayments.

Specified low-income Medicare beneficiary (SLMB)
Individual monthly income < $1,208 Married monthly income < $1,627
Individual resources < $7,280 Married resources < $10,930
People at this level receive assistance with part B premiums only.

Qualified Individual Program
Individual monthly income $1,357 Married monthly income < $1,823
Individual resources $7,280 Married resources < $10,930

Countable resources include money in checking or savings accounts, stocks and bonds. Assets not counted are your home, one car, burial plot, up to $1,500 in burial expenses, furniture and other household and personal items.

Not that we see what level of income and resources allot what amount of benefit, let’s take a closer look at dual eligible plans.

Dual eligible plans are designed to coordinate Medicare and Medicaid benefits.

The advantages to having a dual eligible plan as compared to straight Medicare can be seen in in both benefits and patient care.

In a 2012 study by Avalere Health, it was found that enrollees also had a 31 percent lower discharge rate, 43 percent lower rate of days spent in the hospital, 19 percent lower average length of stay, 9 percent lower rate of emergency visits, and a 21 percent lower readmission rate than dual eligibles nationwide who are enrolled in traditional Medicare.

The bottom line: This coordinated, integrated care model kept enrollees out of the hospital and produced fewer readmissions than traditional Medicare coverage.

As if the benefits of coordinated care weren’t enough, the dual eligible plans, also known as special needs plans or SNiP’s, add a few incentives that do help folks out a lot. Many plans offer transportation to doctor visits and an over the counter monthly allowance to pick up non-prescription items such as bandages, ointments, etc.

There are approximately 9.3 million people who qualify for dual eligible plans. Of that only about 20% are taking advantage of the SNPs. That leaves roughly 7,200,000 people who could be receiving better care and more benefit than they are currently getting through Medicare alone. If you or someone you know thinks they may qualify for assistance contact your SSA for more details. If you find you do qualify, it would be in your best interest to contact a professional to learn more about these attractive and underutilized dual eligible plans.

BGA Insurance Group is based in the Philadelphia area and can assist seniors in New Jersey, Pennsylvania, Allentown, and Delaware.