Can you have a Medicare Advantage Plan and Medicaid at the Same Time?

For those who meet income eligibility, Medicaid can be an important resource for covering healthcare expenses that Medicare does not. In addition, some people can benefit from having both Medicaid and Medicare Advantage, which is Medicare coverage through private insurance companies. Those who qualify are known as “dual eligibles.” Learn more about how it works.

The short answer is yes – in certain cases. People who qualify for both Medicare and Medicaid and are called “dual eligibles.” With both types of coverage, most health care costs and expenses will be covered, and there will be very few out-of-pocket costs.

Medicare coverage can be through Original Medicare or via a Medicare Advantage Plan, which is administered by a private plan. Those who qualify for Medicaid, which is offered jointly by the federal government and each state, will also be covered for services that aren’t covered by Medicare.

“In a dual special needs plan, the Medicare Advantage plan will coordinate with their Medicaid plan,” says Ryan Watts, who leads Choice Health Insurance at Alight. This will result in a number ofseveral extra benefits for things that aren’t covered or are only partially covered by Medicare, including dental benefits, dentures, glasses vouchers, hearing aids, home health services, nursing home care, transportation to and from doctors, and Meals on Wheels, he adds.

Medicaid eligibility varies by state. In addition, enrolling in a specialized dual plan can be tricky to do on your own, says Watts. “If you enroll in a plan that does not coordinate premiums, you could pay a higher cost,” he warns. To avoid that, he recommends working with a broker or working closely with a plan provider to go over all the details.

Medicaid is always the secondary payer when it comes to health insurance, says Watts.

“Medicaid never pays first for services covered by Medicare.” Instead, it pays for whatever isn’t covered by Medicare. Medicaid may also cover some drugs and additional services that the Medicare Advantage plan doesn’t cover fully or at all.

“Medicaid is a great benefit for consumers who are eligible,” says Watts. However, if you don’t meet the criteria, he recommends looking into other avenues of help that may be available. For instance, if you don’t qualify for Medicaid, you may qualify for a Low Income Subsidy (LIS). “LIS helps cover prescription card costs, and pays for a portion of your drugs as well,” says Watts.

Some states like New York may have pharmacy assistance programs, as well as additional help from private drug companies.

The terminology around QMB and Medicare/Medicaid can get confusing and can vary by state, says Watts. A QMB is a Qualified Medicare Beneficiary program, which means that Medicare premiums and coinsurance and copayment for Medicare-covered services are covered by Medicaid.

A QMB Plus program (sometimes referred to as QMB Medicaid) is when someone gets full Medicaid benefits.

Either way, these QMB programs do work with both Original Medicare and Medicare Advantage plans. Because these plans can be confusing, it’s a wise idea to consult with someone or connect with a plan provider who can clearly explain your options.

This expert was consulted for insight into understanding Medicare Advantage premiums:

Ryan Watts, CEO of Choice Health Insurance (acquired by Alight Solutions)