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Medicare with Medicaid, and Medicare through disability
If you have both Medicare and Medicaid, or you are under 65 and on Medicare because of a disability, your options are different — usually better than you have been told.
These two groups get the least attention and often need the most help. Plans exist that are built specifically for them, assistance programs exist that many people never hear about, and the enrollment rules are considerably more flexible than they are for everyone else.
Having both Medicare and Medicaid
If you qualify for Medicare and also for Ohio Medicaid, you are what the system calls "dual eligible." In practice that means two programs are coordinating to cover your care, and there is a whole category of plan designed for exactly that arrangement.
Dual Eligible Special Needs Plans (D-SNPs)
A D-SNP is a type of Medicare Advantage plan restricted to people who have both Medicare and Medicaid. Because the plan knows Medicaid is also involved, it is built to work with it rather than around it.
- Costs are typically very low, because Medicaid covers much of what would otherwise be your share.
- Benefits are usually richer — dental, vision, hearing, transportation to appointments and over-the-counter allowances are common on these plans.
- Care coordination is a standard feature, which matters when several conditions and several doctors are involved.
- Availability is county-specific, so what exists in Portage County may differ from Trumbull or Mahoning.
You can usually change plans more often
Most people are limited to the Annual Enrollment Period each fall. People who have both Medicare and Medicaid, or who receive certain assistance, generally qualify for Special Enrollment Periods that allow changes at other points during the year. If a plan is not working for you, you are very often not stuck with it until October.
Programs that lower your costs
Two programs in particular go unclaimed by people who qualify for them. Both are worth checking even if you are not certain you are eligible.
| Program | What it does |
|---|---|
| Extra Help (Low Income Subsidy) |
Reduces or eliminates Part D premiums, deductibles and prescription copays. Administered through Social Security, and qualifying for it also opens a Special Enrollment Period. |
| Medicare Savings Programs | State programs that can pay your Part B premium, and depending on the level, deductibles and coinsurance as well. Qualifying for one generally qualifies you for Extra Help automatically. |
| Ohio Medicaid | Depending on income and assets, may cover costs Medicare does not, including long-term services and supports. |
Income and asset limits change annually and eligibility is decided by the relevant agency, not by me. What I can do is tell you whether it is worth applying and point you at the right office. It very often is worth applying — people talk themselves out of it based on out-of-date figures they heard years ago.
Medicare through disability, under 65
If you have received Social Security Disability Insurance for 24 months, you generally become eligible for Medicare regardless of your age. People with ALS or end-stage renal disease have different, faster rules.
Your Part A and Part B benefits are the same as anyone else's. Medicare Advantage and Part D plans are available to you on the same terms. The area where under-65 beneficiaries face a real difference is Medicare Supplement coverage.
Supplements before 65 in Ohio
Federal law does not require insurers to sell Medigap policies to people under 65, and availability and pricing for under-65 beneficiaries vary considerably by state and by carrier. Where policies are offered to this group, premiums are frequently much higher than for someone at 65.
The practical consequence is that Medicare Advantage or a D-SNP is often the more workable route before 65 — and that when you do turn 65, you get a fresh Medigap Open Enrollment window. That second window is a genuine opportunity and it is worth marking on the calendar years in advance.
What to have ready when we talk
- Your red, white and blue Medicare card
- Your Ohio Medicaid card, if you have one
- Any letter you have received about Extra Help or a Medicare Savings Program
- A complete list of prescriptions with doses
- A list of your doctors and preferred hospital
- Whether you need transportation to appointments
None of it is required to start the conversation. Call with what you have and we will fill in the gaps together.
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.
Irwin Health & Life Insurance is not connected with or endorsed by the United States government or the federal Medicare program. This site is intended as general information and as a solicitation for insurance. A licensed agent may contact you.
You may have more options than you were told
Dual eligible plans, Extra Help and Savings Programs go unclaimed constantly. One call establishes whether any of them apply to you.