Getting Medicaid Benefits With Medicare: An Overview From medicaid-guide.org

Those covered by Medicare or Medicaid may not receive all the benefits they require, and they may choose to seek other means of coverage. However, the team at medicaid-guide.org encourages anyone who qualifies for Medicare and Medicaid to utilize both services to complement their existing health insurance benefits. For instance, Medicare cannot support chronic health conditions or long-term care needs, but Medicaid funds long-term care services. Still, lack of coverage is commonly seen throughout the U.S., and citizens often do not know how to obtain sufficient coverage. Purchasing additional health insurance is not an option for some participants in government assistance programs like Medicaid. While the amount of medical coverage beneficiaries can receive from Medicare and Medicaid depends on each participant’s Medicare plan (Original Medicare or Medicare Advantage), everyone should know how they can capitalize on potential coverage benefits.

Dual Eligibility

Employing both Medicare and Medicaid improves the extent and quality of health care coverage for the beneficiary. Not only will combining the health insurance programs allow a patient to expedite his or her care, but premiums and deductibles may also lower because of the doubled coverage. Dual-eligible patients - those who receive Medicare and Medicaid benefits - may automatically enroll in the Qualified Medicare Beneficiary (QMB) Program, Specified Low-Income Medicare Beneficiary (SLMB) Program or the Qualifying Individual (QI) Program – all operated by the Medicare Savings Program (MSP). The QMB program enables beneficiaries to pay additional costs they may incur for hospital visits and basic doctor appointments, such as copayments and coinsurance fees, whereas the SLMB and QI programs fund general medical care only. Other programs associated with dual eligibility may assist recipients with disabilities and support long-term care costs.

Integrating Medicare and Medicaid programs helps patients access care and afford necessary procedures or treatments as well. The team at medicaid-guide.org recommends that those who attain dual eligibility for Medicare and Medicaid programs properly report insurance changes and claims to ensure optimal coverage. Additionally, the team at medicaid-guide.org reminds readers that specific dual-eligibility benefit packages may vary by state due to differing charges and eligibility requirements.

Coordination of Benefits

When multiple insurers are present, the insurers must decide how an insured individual’s medical costs will be divided. This process is known as Coordination of Benefits. The Medicare-Medicaid Coordination Office manages care between Medicare and Medicaid and collaborates with the insurers to ensure patients receive the most effective cost-saving combination of benefits without overlapping coverages. The team at medicaid-guide.org suggests that beneficiaries also seek guidance from their local Medicare or Medicaid representatives to best coordinate multiple insurance benefits and determine health insurance costs. However, Medicare will perform as a patient’s primary insurer. Services that Medicare and Medicaid cover are billed directly to Medicare, but services mostly offered by Medicaid, such as nursing home or personal care, remain under Medicaid’s coverage. The team at medicaid-guide.org informs readers that Medicaid insurance may become a Fee-for-Service (FFS) coverage system after merging with Medicare. This payment method pays health care providers for individual services and may complicate a patient’s medical charges.