Medicare, Medicaid, and How They Work Together

What is Medicare?

Medicare is health insurance from the federal government. Most people can get it at age 65. Some younger people with certain disabilities can get it too.

Medicare has different parts:

• Part A helps pay for hospital stays.
• Part B helps pay for doctor visits and other care.
• Part D helps pay for prescription drugs.

Medicare covers a lot, but not everything. For example, it does not pay for most long-term care — like daily help at home with bathing, dressing, or meals or supplemental benefits like dental, vision or hearing. 

What is Medicaid?

Medicaid is a program run by the state and the federal government. In New York, it is called New York Medicaid. It helps people who have limited income and savings.

Medicaid can help pay for things Medicare does not fully cover. This can include long-term care. It can also help pay some of your Medicare costs.

What does it mean to have both?

Some people qualify for both Medicare and Medicaid. When you have both, you are what many people call "dual eligible."

If you have both, you may carry two cards: a red, white, and blue Medicare card and a New York Medicaid card. Having both usually means more of your care is covered. Many people who have both pay little or nothing for covered care.

Can one plan bring them together?

Yes. A special kind of plan can combine your Medicare and Medicaid into one plan. This is called a Dual Eligible Special Needs Plan, or D-SNP.

With one plan, you can have:

• One member card for most of your care
• One team to help you
• Extra benefits that Medicare alone may not offer

You still keep the benefits you get from both Medicare and Medicaid. The plan just helps them work together, so you have less to juggle.

What if you need daily help at home?

Some people need daily help to stay safe at home. This is called long-term care. It can include help with bathing, dressing, cooking, and taking medicine.

Elderplan can help with this in two ways:

• Provide one plan that combines Medicare, Medicaid, and long-term care. This is for people who have both Medicare and Medicaid and need daily help at home.
• A Medicaid long-term care plan, called HomeFirst. This covers long-term care through Medicaid. It is not a Medicare plan, so you keep your Medicare separate.

To join a Medicaid long-term care plan in New York, you usually start by calling New York Medicaid Choice. We can walk you through it.

A quick look at Elderplan's plans

Elderplan offers five plans for different needs. The right one depends on your situation — like where you live and whether you have Medicare, Medicaid, or both.

• Have both Medicare and Medicaid and live at home? There is a plan that brings both together.
• Have both and need daily help at home? There is a plan that adds long-term care.
• Need long-term care at home through Medicaid? HomeFirst may fit.
• Live in assisted living, or need that level of care? There is a plan for that.
• Live in a nursing home? There is a plan made for nursing home residents.

Not sure which one fits? Use our plan finder or call us. We will help you find the right plan for you.

What will you pay?

What you pay depends on your plan and your Medicaid. Many people who have both Medicare and Medicaid pay little or nothing for covered care.

If you have Medicare Part B, you may still need to pay your Part B premium — unless Medicaid pays it for you.

To see the exact costs for a plan, read that plan's Summary of Benefits.

Not sure what you have or what you qualify for?

That is okay. Many people are not sure at first, and you do not have to figure it out alone.

• Already a member? Call the number on your member ID card.
• Looking for a plan? Call us or use our plan finder.
• Want to check your Medicaid? Contact New York Medicaid or your local Department of Social Services.

Good to know

This guide gives you a simple overview. It is not a complete list of rules or benefits. For full details, read your plan's Evidence of Coverage and Summary of Benefits. If anything here is different from those documents, those documents are correct.