Medicare and Medicaid are not the same thing—and for many Florida seniors, having both can make a big difference.
If you or a loved one has Medicare, you may have wondered:
“Do I also qualify for Medicaid?”
The answer may be yes.
At Life and Med – Medicare Resource Center, we help Florida families understand how Medicare, Medicaid, and Medicare Savings Programs can work together. These programs can be confusing, especially when you’re trying to figure out what you qualify for, what you might have to pay, and what happens if you eventually need long-term care.
Let’s break it down in plain English.
Medicare vs. Medicaid: What’s the Difference?
Medicare is federal health insurance. Most people become eligible around age 65, regardless of their income or assets.
Florida Medicaid is a joint federal and state program for people who meet specific financial and eligibility requirements. For seniors, Medicaid can help with Medicare costs and may also cover certain services that Medicare does not cover.
The important thing to remember is:
You don’t necessarily have to choose between Medicare and Medicaid. You may be able to have both.
When someone qualifies for both programs, they’re often referred to as dual eligible.
What Does Medicare Cover?
Medicare generally helps pay for:
- Hospital care
- Doctor visits
- Outpatient medical services
- Preventive care
- Skilled nursing care for qualifying situations
- Prescription drugs through Part D
- Certain medical equipment and supplies
Medicare Advantage plans may also provide additional benefits such as dental, vision, hearing, transportation, and other supplemental benefits, depending on the plan.
But there is one area where families often get surprised:
Medicare generally does not pay for long-term custodial care.
That includes ongoing help with everyday activities such as bathing, dressing, eating, or getting around when skilled medical care is no longer required.
That’s where Medicaid may become extremely important.
What Can Florida Medicaid Help With?
Depending on the program a person qualifies for, Florida Medicaid may help with:
- Medicare premiums
- Medicare deductibles and coinsurance
- Prescription drug costs
- Transportation to medical appointments
- Certain dental and vision services
- Personal care services
- Home and community-based services
- Long-term care services
For eligible individuals, Medicaid can be an important piece of the overall healthcare and financial picture.
Can You Have Medicare and Florida Medicaid at the Same Time?
Yes.
In fact, many Florida seniors have both.
Generally, Medicare pays first, and Medicaid pays second.
If you qualify for full Medicaid benefits, Medicaid may help with Medicare cost-sharing and provide additional benefits that Medicare doesn’t cover.
There are also Medicare Savings Programs (MSPs) that can help people who don’t qualify for full Medicaid but have limited income and resources.
Medicare Savings Programs: Don’t Assume You Make Too Much
This is one of the areas we encourage seniors and families to look into carefully.
Florida’s Medicare Savings Programs include:
QMB – Qualified Medicare Beneficiary
QMB can help pay Medicare Part A and Part B premiums and Medicare cost-sharing for eligible individuals.
SLMB – Specified Low-Income Medicare Beneficiary
SLMB can help pay the Medicare Part B premium for people who meet the program requirements.
QI – Qualifying Individual
QI can also help pay the Part B premium for eligible individuals, although funding is limited and enrollment is subject to program rules.
The big takeaway: Don’t automatically assume you won’t qualify because you receive Social Security or have some money in the bank.
The rules are specific, and eligibility depends on your individual circumstances.
What About Long-Term Care?
This is one of the biggest misconceptions we hear from families.
“Does Medicare pay for a nursing home?”
Medicare may cover short-term skilled nursing care when specific requirements are met.
But Medicare generally does not pay for ongoing custodial long-term care.
Florida Medicaid may help eligible individuals with long-term care through programs such as the Statewide Medicaid Managed Care Long-Term Care program and the Institutional Care Program.
And planning matters.
If you think you or a parent may need long-term care in the future, don’t wait until you’re already in crisis mode to start asking questions.
What Is a D-SNP?
If you have both Medicare and Medicaid, you may hear the term D-SNP, which stands for Dual Eligible Special Needs Plan.
A D-SNP is a type of Medicare Advantage plan specifically designed for people who qualify for both Medicare and Medicaid.
These plans are designed to coordinate benefits and may include additional benefits such as:
- Dental
- Vision
- Hearing
- Transportation
- Over-the-counter allowances
- Care coordination
However, one D-SNP isn’t automatically right for everyone.
Provider networks matter.
Before changing plans, make sure your doctors, specialists, hospitals, and other important providers participate in the plan.
A Very Important Tip for QMB Beneficiaries
If you’re enrolled in the Qualified Medicare Beneficiary (QMB) program, federal law generally protects you from being billed for Medicare-covered Part A and Part B cost-sharing.
If you receive a bill that you believe you’re not supposed to pay, don’t simply write the check.
Ask questions and make sure the provider knows you’re enrolled in QMB.
How Life and Med Can Help
At Life and Med – Medicare Resource Center, we believe Medicare shouldn’t feel like you need a law degree to understand it.
We can help you look at the bigger picture—not just your Medicare plan.
That can include questions about:
- Medicare Advantage
- Medicare Supplements
- Prescription drug coverage
- Medicare Savings Programs
- Medicaid
- Dual-eligible plans
- D-SNPs
- Enrollment periods
- Comparing your current coverage with your available options
And if Medicaid eligibility is involved, we’ll help you understand where to go and what questions to ask. Financial eligibility for Medicaid and Medicare Savings Programs is determined by the appropriate government agencies, so we don’t make promises about eligibility—but we can help you understand the process.
Don’t Leave Money or Benefits on the Table
One of the biggest mistakes families make is assuming:
“Mom already has Medicare, so she’s covered.”
Medicare may be covering her medical care, but there could be additional programs available to help with Medicare costs or services Medicare doesn’t cover.
If you live in Leesburg, Lake County, or the surrounding Central Florida area, we’re right here to help you understand your options.
Life and Med – Medicare Resource Center
Patricia Saint Louis, RN
Medicare & Health Insurance Broker
216 N. 3rd St., Suite B
Leesburg, FL 34748
352-260-0202
Medicare can be complicated. Getting help shouldn’t be.
*This information is for educational purposes only. Medicaid and Medicare Savings Program eligibility is determined by the appropriate government agencies and depends on individual circumstances and current program rules.*