How Does Medicaid Work with Medicare Advantage Plans?

Medicaid coverage is often essential for many seniors’ lives in today’s world. However, there are many benefits and necessities that aren’t always covered in the standard Federal programs and plans. That’s why Medicare programs are designed to help give you the additional coverage you need. Medicare Advantage plans offer many of these additional benefits while working hand in hand with your individual Medicaid. While enrolling in a Medicare Advantage plan is optional, Medicare Advantage plans at Exact Benefits are some of the best Medicare programs to help you with the wellness programs you need. This plan can provide you with all your needed benefits not included in your original Medicaid program.


Understanding Medicaid and Medicare Advantage

In order to decide what programs are good for you, it is essential to understand the advantages of each plan that best suit your needs and preferences. Medicaid is a US government-sponsored program designed specifically for people with limited income. This plan provides healthcare for individuals and families of all ages to afford their medical needs.

Medicare, in general, is targeted at people over 65 or those with a disability. Medicare has little to do with income and is a good program for those without access to other resources. Medicare Advantage is a service we offer at Exact Medicare, which are plans that add additional benefits to the original Medicare plan. Medicare Advantage offers dental, hearing, and vision coverage along with prescription drug coverage and wellness programs that offer gym memberships.


Dual Eligibility: Medicaid and Medicare Advantage

If you are over 65 and have a disability, as well as living off a lower income, there is a good chance you are eligible for both programs. While both plans were created for separate purposes, the two are designed to work well together. Medicare Advantage can give you the benefits you need that aren’t included in the Medicaid plan.


Medicaid and Medicare Advantage Integration

With Medicare Advantage, dual-eligible individuals can primarily receive their coverage through the US Government sponsored Medicaid, but receive additional benefits with Medicare Advantage. Dual Eligible Special Needs Plans, or D-ESNPs, must coordinate with your Medicaid programs and deliver the benefits you need. They offer more coverage and an alternative way to receive your Medicare benefits. Medicare Advantage plans- while having lower out-of-pocket costs- each have their own costs and benefits, so it’s important to know what you’re looking for before applying.

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Cost Sharing and Coverage

It’s important to remember that each Medicare Advantage program is different. Some programs have no additional premium, but others may have a monthly premium. Also, remember that you generally have to get your care from providers who participate in the plan’s network. On the other hand, if you suffer from a chronic condition and require many doctor visits or specialized treatment, Medicare Advantage gives just the benefits you need. This plan provides a network of providers to choose from to help keep the prices low. Medicare Advantage plans can also cover dental, vision, hearing, prescription drugs, wellness programs, and many additional benefits. If this coverage is what you are looking for in a Medicare plan, Medicare Advantage might be perfect for you. 

Enrollment and Plan Options

The Annual Enrollment Period– or AEP- is the time of the year when you can apply or switch Medicare programs. The time frame usually runs from October 15th to December 7th, so keep that in mind when deciding if you’d like to apply. Individuals will still be required to pay their monthly Medicare Part B premium in addition to the Medicare Advantage plan.


Medicare Advantage programs at Exact Benefits are great plans for those individuals who are eligible for both Medicaid and Medicare assistance. Not only do we have low and affordable costs, but these programs can also work with your Medicaid to give you the additional benefits you need. Medicare Advantage is designed to work hand in hand with your Medicaid program to give you more coverage, a large provider network, and lower out-of-pocket costs. If you’re interested in learning more or would like to enroll in a Medicare Advantage program, schedule an appointment or call (380) 242-2006 to speak to our specialists.