Introduction to Medicare
Medicare, Medicaid and Dual Eligibility
Medicare and Medicaid
The words "Medicare" and "Medicaid" are so much alike that it's easy to get them confused. Both are government programs and both help people pay for health care. But that's where the similarities end. Check out the chart below to see the main differences.
What they are:
Medicare
- A federal health insurance program for people who are:
- 65 or older
- Under 65 with certain disabilities
- Of any age and have End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig's Disease)
Medicaid
A joint federal and state program that helps pay health care costs for certain individuals and families with limited income and resources.
Who offers them:
Medicare
Federal government
Medicaid
State government
What they cover:
Medicare
Depends on the coverage you choose and may include:
- Care and services received as an inpatient in a hospital or skilled nursing facility (Part A)
- Doctor visits, care and services received as an outpatient and some preventive care (Part B)
- Prescription drugs (Part D)
Medicaid
Each state creates its own Medicaid program, but has to follow federal guidelines, like the required and optional benefits they include. Some of the benefits Medicaid programs have to include are:
- Care and services received in a hospital or skilled nursing facility
- Care and services received in a federally-qualified health center, rural health clinic or freestanding birth center (licensed or recognized by your state)
- Doctor, nurse midwife, and certified pediatric and family nurse practitioner services
What they cost:
Medicare
It depends on the coverage you choose. Costs may include premiums, deductibles, copays and coinsurance.
Medicaid
It depends on your income and the rules in your state. Costs may include premiums, deductibles, copays and coinsurance.
How to get them:
Medicare
Many people are enrolled in Parts A and B automatically when they turn 65. You can also contact your local Social Security office to see if you are eligible.
Medicaid
Eligibility depends on the rules in your state. Call your State Medical Assistance (Medicaid) office to see if you qualify.
Dual Eligibility
Individuals who qualify for both Medicare and Medicaid at the same time are called "dual" or "dual eligible." Dual Special Needs Plans, or DSNPs, are designed specifically for dual-eligible people. DSNPs include at least the same coverage as Original Medicare Part A and Part B benefits, as well as Part D prescription drug coverage in one plan. For people with limited incomes, these plans can offer better health care coverage than Original Medicare and a separate, standalone Part D plan.
How do I qualify?
To qualify for a DSNP, you must receive Original Medicare (Parts A and B) and full Medicaid benefits. This means Medicaid pays for all or part of your Medicare copayments, coinsurance and deductibles. Most of the time, individuals who qualify get a letter from their state Medicaid office. You can also call them to find out your status.
How do they work?
Medicaid benefits can help pay for the costs of a DSNP. Plus, DSNPs often provide additional benefits not offered by Medicare, such as routine hearing, vision and dental care, as well as coverage for transportation.
How can I find out more?
For information about dual-eligible programs, call Social Security toll-free at 1-800-772-1213, TTY 1-800-325-0778, 7 a.m. to 7 p.m. local time, Monday through Friday. Or contact your state Medical Assistance or Medicaid office.
UnitedHealthcare and AARP Medicare Plans
See all of the Medicare Advantage, Medicare Prescription Drug, and Medicare Supplement plans where you live.
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AARP® encourages you to consider your needs when selecting products and does not make product recommendations for individuals.
Please note that each insurer has sole financial responsibility for its products.
AARP® Medicare Supplement Insurance Plans
AARP endorses the AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company.
Insured by UnitedHealthcare Insurance Company, 185 Asylum Street, Hartford, CT 06103 (available in all states/territories except ND, NY) or UnitedHealthcare Insurance Company of America, 1600 McConnor Parkway, Floor 2, Schaumburg, IL 60173 (available in AR, AZ, IL, IN, MS, NC, ND, NJ, OH, PA, SC, TN, TX) or UnitedHealthcare Insurance Company of New York, 2950 Expressway Drive South, Suite 240, Islandia, NY 11749 (for NY residents). Policy Form No. GRP 79171 GPS-1 (G-36000-4).
In some states, plans may be available to persons under age 65 who are eligible for Medicare by reason of disability or End-Stage Renal Disease.
Not connected with or endorsed by the U.S. Government or the federal Medicare program.
This is a solicitation of insurance. A licensed insurance agent/producer may contact you.
You must be an AARP member to enroll in an AARP Medicare Supplement Plan.
THESE PLANS HAVE ELIGIBILITY REQUIREMENTS, EXCLUSIONS AND LIMITATIONS. FOR COSTS AND COMPLETE DETAILS (INCLUDING OUTLINES OF COVERAGE), CALL A LICENSED INSURANCE AGENT/PRODUCER AT THE TOLL-FREE NUMBER ABOVE.
Medicare Advantage plans and Medicare Prescription Drug plans
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan's contract renewal with Medicare. You do not need to be an AARP member to enroll in a Medicare Advantage plan or Medicare Prescription Drug plan.
This information is not a complete description of benefits. Contact the plan for more information.
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