Qualifying for Medicare hardly means free health care — there are still premiums and deductibles. However, people who qualify for both Medicare and Medicaid (called “dual eligibility”) receive help paying their out-of-pocket costs.

What is Medicare?

Medicare is a federal program available to anyone 65 or older. It consists of four major parts, each of which have premiums and co-pays associated with them:

  • Part A covers hospital stays and some limited nursing home stays as well as hospice benefits
  • Part B covers office visits, physician fees, medical equipment, home care, and preventative services
  • Part C (called Medicare Advantage) permits Medicare beneficiaries to receive Part A and B benefits from private insurance companies
  • Part D covers prescription medications

What is Medicaid?

Medicaid is a joint federal and state program that provides health insurance to low-income adults, children, and people with disabilities. It is also the primary method of paying for nursing home care and community-based long term care. To qualify for coverage, applicants must have limited assets and income.

What is Dual Eligibility?

To be considered dually eligible, beneficiaries can be enrolled in either Medicare and full Medicaid or in Medicare and one of Medicaid’s Medicare Savings Programs. Medicare Savings Programs are state programs, run through Medicaid, that provide help paying for Medicare premiums. When Medicare and Medicaid coverage overlap, Medicare always pays for the services first. If Medicare doesn’t cover the full cost, then Medicaid may cover the remaining cost. Medicaid may also cover some costs that Medicare does not cover, like long-term nursing home care.

What are the benefits of dual eligibility?

The benefits available to dual eligible beneficiaries depend on which Medicaid program the beneficiary is enrolled in:

  • Full Medicaid. Beneficiaries receive full Medicaid coverage. Because Medicaid is a state-run program, additional benefits can vary by state. Some states may pay Medicare’s Part B premiums. In addition, beneficiaries do not have to pay more than the amount allowed under the state’s Medicaid program for services by Medicare providers.
  • Qualified Medicare Beneficiary (QMB) Program. Beneficiaries receive help paying Part A and Part B premiums, deductibles, coinsurance, and copayments.
  • Specified Low-Income Medicare Beneficiary (SLMB) Program. Beneficiaries receive help paying Part B premiums.
  • Qualifying Individual (QI) Program. Beneficiaries receive help paying Part B premiums but help is limited on a first-come, first-served basis.
  • Qualified Disabled Working Individual (QDWI) Program. Pays Part A premiums for certain disabled and working beneficiaries under 65 who meet certain income and resource limits set by their state.

Planning for Medicaid and navigating the Medicaid application process is complicated and can be daunting.  For expert assistance understanding Indiana Medicaid laws, contact Stinson Law Firm for assistance. Our Indianapolis Medicaid attorneys will guide you through the steps you should take to protect the family members you love.

How our Indianapolis Medicaid Attorneys Can Help

If you live in Indianapolis, IN, and need assistance handling the Medicaid process, the legal team at Stinson Law Firm can help. Our Indianapolis Medicaid Attorneys have helped hundreds of Indianapolis residents get through the Medicaid process. We can guide you through every step of your Medicaid process.

Let our Medicaid attorneys provide you peace of mind with care and compassion.

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