Health Coverage For Low-Income Seniors Enrolled In Medicare Through Medicaid

doctor in foreground interior of hospital in background

By Patricia LaCroix, Contributing Writer

Are you — or is someone you care for — an older adult in need of health coverage but also low on income? For low-income American seniors who are enrolled in Medicare, the Medicaid program helps to fill the gap.

Medicaid provides health coverage to 7.2 million low-income seniors already enrolled in Medicare, as well as 4.8 million people with disabilities. In total, 12 million people are “dually eligible” and are enrolled in both Medicaid and Medicare. By federal statute, individuals who are enrolled in both Medicaid and Medicare can be covered within both optional and mandatory categories.

How Medicaid works with Medicare

Let’s first go over what Medicare offers to seniors. Medicare provides four basic forms of health coverage, known as Parts A, B, C, and D. Here’s the breakdown of all the parts and what each covers:

  • Part A: Pays for hospitalization costs
  • Part B: Pays for physician services, lab and x-ray services, durable medical equipment, and outpatient and other services
  • Part C: Medicare Advantage Plans (like an HMO or PPO) offered by private companies approved by Medicare
  • Part D: Assists with the cost of prescription drugs

How does Medicaid play a role in helping low-income Medicare enrollees?

  • Medicaid can help low-income seniors enrolled in Medicare with premium payments and out-of-pocket medical expenses.
  • Medicaid can also cover additional services beyond those provided under Medicare. Such care can include:
    • nursing facility care beyond Medicare’s 100-day limit
    • skilled nursing facility care
    • prescription drugs
    • eyeglasses
    • hearing aids

Services covered by both programs are first paid by Medicare. The difference is then picked up by Medicaid. up to the state’s payment limit.

For specific eligibility standards and benefits for the current year, CLICK HERE to visit Medicaid’s website and learn more.

Information courtesy of Medicaid.gov.