Do You Need Medigap if You're Eligible for Both Medicare and Medicaid?

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Do You Need Medigap if You're Eligible for Both Medicare and Medicaid?

A person with a shopping cart already containing medicaid and medicare sees Medigap options on a table. In a thought bubble, they ask "Should I get Medigap too?"

By Daniel Petkevich

Jan 7, 2023

You may enroll in more than one plan, but you don't need all three. Here's why:

Medicare, Medicaid, and Medigap (also known as Medicare Supplement) often overlap; sometimes, people sign up for more than one plan. But is there ever a time when you should enroll in all three?

Stay Up to Date on Medicare!

We want you to get the best benefits possible, so we'll walk you through everything you need to know.

Let's explore Medicare, Medicaid, and Medigap in more detail, get a sense of their differences, and discuss whether to enroll in more than one plan.

What's the Difference Between Medicare, Medicaid and Medigap?

Medicare, Medicaid and Medigap all assist in covering your healthcare expenses. But they help different populations and meet unique needs.

Let's take a look at each plan.

Medicare

Medicare

is a health insurance program administered by the U.S. federal government.

It provides coverage to people ages 65+ and those with disabilities or

ESRD

(end-stage renal disease).

There are four parts to Medicare:

Part A — part of Original Medicare; covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home healthcare
Part B — part of Original Medicare; covers medically necessary services and preventive care, such as doctor visits, lab tests, and durable medical equipment
Part C (Medicare Advantage) — alternative to Parts A and B offered by private insurance companies; combines all the benefits of Parts A and B and often includes additional benefits, such as prescription drug coverage
Part D — prescription drug benefit that can be added to Original Medicare (Parts A and B) or a Part C plan

Medicaid

Medicaid is a joint federal and state program that provides health insurance to low-income individuals and families — including the elderly, individuals with disabilities, children, and pregnant women.

Medicaid might cover a wide range of medical services, such as:

Doctor visits
Hospital stays
Prescription drugs
Long-term care
Immunizations
Screenings

Medicaid is administered by the states (rather than at a federal level). And each state has its own eligibility criteria and benefits. To be eligible for Medicaid, you must meet your state's income and asset requirements.

Medigap

Medigap is a supplemental insurance policy that supplements Original Medicare (Part A and Part B).

It helps cover certain out-of-pocket costs — like copayments, coinsurance, and deductibles. However, it doesn't cover

long-term care

, vision, dental, hearing aids, private-duty nursing, and prescription drugs.

Medigap policies are offered by private insurance companies and are standardized by the federal government. You can choose from

10 Medigap plans

depending on your requirements.

Medicare Supplement Plan G

offers the most comprehensive coverage for many of our clients.

Can I Get Both Medicare and Medicaid Benefits Together?

Yes. You can benefit from Medicare and Medicaid if you're dually eligible. In other words, you have to meet the eligibility requirements for both Medicare and Medicaid.

To be dually eligible, you must meet the following conditions:

Be 65 years or older or have a disability (like ESRD)
Have a low income

How Do Medicare and Medicaid Work Together?

Medicare covers 80% of your healthcare expenses, while Medicaid helps cover the remaining out-of-pocket costs left by Medicare Parts A and B.

In other words, Medicare covers services that Medicaid doesn't and vice versa.

For example, Medicare may cover your hospital stays, doctor visits, and lab tests, while Medicaid covers your additional expenses like premiums, prescription drugs, eyeglasses,

hearing aids

and long-term care. Both work together to maximize your benefits and provide comprehensive coverage.

To better understand how these two programs work together, you need to be familiar with two terms: coordination of benefits and crossover claims.

What Is Coordination of Benefits?

When a person has multiple health insurance plans (like Medicare and Medicaid), providers must coordinate their benefits to avoid overpaying or duplicating coverage. Coordination of benefits determines which health insurance plan should pay for a medical service or claim first.

"Primary" payer — the insurance plan that pays first
"Secondary" payer — the plan that pays second

In general, Medicare is the primary payer, and Medicaid is the secondary payer. This means Medicare will pay for covered medical services first, and Medicaid will pay for any remaining expenses not covered by Medicare — like copayments, deductibles and coinsurance.

What's a Crossover Claim?

A crossover claim is a medical claim submitted to multiple insurance plans. They're used when an individual has two insurance plans that coordinate their benefits.

For example, if you’re enrolled in both Medicare and Medicaid, your provider will submit the claim to Medicare. Medicare will process the claim first and apply any deductibles, coinsurance, or copayments. The claim will then be automatically forwarded to Medicaid. (Note: Your provider doesn't have to bill Medicaid separately for the deductible, coinsurance, or copayments that Medicare applied).

Is Medigap Necessary If You Are Eligible for Both Medicare and Medicaid?

No. You don't need to enroll in a Medigap Plan if you're enrolled in Medicare and are eligible for full Medicaid benefits.

Here's why:

Most of your medical expenses are likely covered if you're dually eligible for Medicare and Medicaid
Insurance companies aren't permitted to sell Medigap policies to Medicare beneficiaries with full Medicaid coverage

I Don't Qualify for Medicaid. Can I Still Get a Medigap Plan?

Yes! Medigap plans are good for individuals who don't qualify for Medicaid. They're especially helpful if you have a high income or assets and need help with out-of-pocket costs not covered by Original Medicare (Parts A and B).

Takeaway

Medicare, Medicaid, and Medigap are all health insurance programs that cover your medical expenses. Medicaid is specifically designed to help low-income individuals pay for out-of-pocket costs. In contrast, Medigap plans often help high-income individuals — who aren't eligible for Medicaid — pay for their out-of-pocket costs.

You don't need to enroll in a Medigap Plan if you're eligible for both Medicare and Medicaid. Medicaid will likely cover most of your out-of-pocket expenses.

Having multiple health insurance plans can give you more comprehensive coverage. But it can also be confusing. At

Fair Square Medicare

, we have helped thousands of beneficiaries understand the ins and outs of Medicare and make informed decisions about their coverage. If you have any questions, give us a call at 1-888-376-2028.

Stay Up to Date on Medicare!

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Notice of Privacy Practices

Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2022 Help Button Inc

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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Do You Need Medigap if You're Eligible for Both Medicare and Medicaid?

You may enroll in more than one plan, but you don't need all three. Here's why:

Stay Up to Date on Medicare!

What's the Difference Between Medicare, Medicaid and Medigap?

Medicare

Medicaid

Medigap

Can I Get Both Medicare and Medicaid Benefits Together?

How Do Medicare and Medicaid Work Together?

What Is Coordination of Benefits?

What's a Crossover Claim?

Is Medigap Necessary If You Are Eligible for Both Medicare and Medicaid?

I Don't Qualify for Medicaid. Can I Still Get a Medigap Plan?

Takeaway

Stay Up to Date on Medicare!

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About

Medicare 101

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