Medicaid Coordination Help

How Medicare and Medicaid Work Together

When you have both Medicare and Medicaid, the two programs work together to cover your healthcare costs. In most situations, Medicare pays first (as the primary payer), and Medicaid pays second, covering some or all of the costs Medicare leaves behind.

The extent to which Medicaid fills the gaps depends on your level of eligibility (full vs. partial dual) and the type of service. This coordination is what makes dual eligibility potentially very valuable, but also difficult to navigate without guidance.

Idaho Medicaid Programs That Help with Medicare Costs

Idaho has several programs that help dual-eligible beneficiaries with Medicare costs:

• Qualified Medicare Beneficiary (QMB): Pays Part A and Part B premiums, deductibles, and copays. One of the most comprehensive programs.
• Specified Low-Income Medicare Beneficiary (SLMB): Pays Part B premiums only.
• Qualifying Individual (QI): Pays Part B premiums. Limited slots available; first-come, first-served.
• QDWI: Pays your Part A premium if you're under 65, disabled, and working.

How to Apply in Idaho

Medicaid eligibility is decided by the Idaho Department of Health and Welfare, not by Medicare and not by me. You apply directly with them, and it costs nothing to find out.

• Apply for Medicaid for elderly or disabled adults. This is the route for most people on Medicare. You can apply online, by phone, in person, or by mail. If you need nursing-home or in-home care, a Level of Care Determination happens after the financial decision, and a higher income limit can apply at that stage.
• Apply for AABD cash assistance. Monthly cash help for Idahoans who are aged, blind or disabled and already receiving SSI. Separate from Medicaid itself, and worth checking if you qualify for one.

The Role of D-SNP Plans

Have both Medicare and Medicaid in Idaho? A D-SNP is often the best way to join them up. These plans are built specifically to bring these two programs together under a single plan with coordinated care management.

D-SNP plans work with both Medicare and Idaho Medicaid. They must help you manage your care across both programs for members.

Extra Help with Part D

If you're a full dual eligible, you automatically get Extra Help. That program cuts your drug costs by a lot. If you're a partial dual, you may still qualify, income and resource limits apply.

Getting Help with Coordination

Medicaid coordination is one of the trickiest parts of Medicare. Mistakes are common. A doctor's office may bill you when it shouldn't. Having a knowledgeable agent who understands both programs is one of the best ways to protect yourself.