Medicare and Medicaid

MediCARE and MediCAID are often confused with being one in the same.  They are completely separate programs in terms of scope and purpose.


Medicare was founded with the goal of providing health insurance to America's seniors, whereas Medicaid was created to give health insurance to low-income individuals regardless of age.

Before going further, we just want to stress that we are NOT Medicaid specialists in any way. We focus solely on Medicare, but we did want to discuss how Medicare and Medicaid can work together since the topic often comes up.

It is also important to note that Medicaid is largely controlled by individual states, which means it can vary greatly across the country. For that reason, we will keep this section to a more high-level discussion. If you have more specific questions concerning Medicaid, please contact your individual state's Department of Health and Human Services. 

CMS states that "The Federal government sets statutes, regulations, and policies. Each State operates within those broad national guidelines and":

  •  Establishes its own eligibility standards

  •  Determines the type, amount, duration, and scope of services 

  •  Sets the rate of payment for services 

  • Administers its own program

How Medicare Works With Medicaid

Depending on the state in which you reside, the degree to which Medicaid will coordinate with Medicare will vary.


For this topic, we will stick with the assumption that the enrollee is fully covered by their state's Medicare program.


In this instance, Medicaid will coordinate with Medicare as a secondary payer.


This essentially means that the states Medicaid coverage will function as a no-cost Medicare supplement. 


However, this is only the case when going to medical providers and facilities that accept both Medicare and Medicaid.

Dual Eligible Special Needs Programs (DSNP's)

For individuals that qualify for both Medicare and full Medicaid benefits, they are considered to be dual eligible (meaning they qualify for both programs).


It is important to note that being dual eligible does not take age into consideration. Dual eligibility applies to anyone that has Medicaid in addition to Medicare (whether that is because they are 65 years or older, or eligible for Medicare due to disability and under age 65).

Dual Special Needs plans provide additional benefits to enrollees at little to no cost.


These benefits can include transportation to doctors, dental coverage, and money for over the counter products.


The trade-off to these programs is you have to join the plans more limited number of health care providers and physicians.