Medicaid is a government-funded health insurance program in the United States that assists low-income families as well as seniors, the blind, and people with disabilities whose income is insufficient to pay for necessary medical treatments. You may qualify for Medicaid based not only on your income but also on a number of other variables, depending on the qualifying group you fall into. However, you might be curious about whether or not you can apply for private health insurance in addition to receiving Medicaid benefits. Even if you and your family currently have private health insurance, you and your dependent children can be eligible for Medicaid if you have a low income and a child or children who are under the age of 18. However, this is only the tip of the iceberg; there are other balls to juggle in order to establish the optimal balance between Medicaid and commercial insurance. Find out more about if you are eligible for both Medicaid and private insurance, whether you can have both types of coverage, and how Medicaid interacts with other types of medical insurance.
Key Takeaways
- Even if you are covered by another health insurance plan, there is a chance that you could still be eligible for Medicaid. The order in which your bills are paid is determined by the coordination of benefits guidelines.
- There are Medicaid programs that pay for services directly, while there are also Medicaid systems that work with commercial insurance companies to provide coverage.
- In order to participate in certain Medicaid qualifying programs, you are required to demonstrate that you do not have access to any other form of medical coverage.
Medicaid vs. Private Insurance
Medicaid and commercial insurance both provide health coverage, but their inner workings are quite different. Medicaid is a government program, whereas private insurance is offered by private companies. Medicaid is a program that is jointly supported by the federal government and the states. It helps families with low incomes cover the cost of medical treatments for their children, pregnant women, older individuals, adults living with disabilities, and women who have either breast or cervical cancer. These persons are required to meet the qualifying income requirements in addition to any other requirements necessary to qualify. Whether or not you and your family are eligible for Medicaid based on your income level is determined by the number of people living in your household as well as the program for which you are applying. Medicaid is a program that allows states a lot of leeways to customize their own programs, including who to cover, the benefits to provide, and the way in which health care services are provided. Although the federal government establishes the minimum standards for Medicaid, this program gives states a lot of flexibility to customize their programs. There are certain benefits that are obligatory for states to provide, but there is also room for states to offer extra voluntary benefits. The majority of people in the United States obtain their health coverage through private insurance, which is offered by commercial health insurance firms rather than by either the state or the federal government. There are two different marketplaces for private health insurance: the group market and the non-group market. Plans that are provided by employers are the primary emphasis of the group market, whereas the non-group market, often known as the individual market, is comprised of policies that are acquired directly from insurance providers. Both on and off of the health insurance marketplaces, individuals can purchase their own plans. Plans purchased individually through a marketplace are required to cover a minimum of ten basic health benefits. Due to the low rates at which Medicaid providers are paid and the relatively modest expenditures associated with administering the program, Medicaid provides coverage at a lower overall cost than commercial insurance. As a consequence of this, beneficiaries of Medicaid are able to take advantage of more extensive services while paying lower out-of-pocket expenditures than they would with commercial health insurance. In point of fact, enrolling adults with similar health statuses in Medicaid is more cost-effective than doing so through private insurance. Insurance for individuals is not something that is offered by state governments. Instead, they enter into contracts with private insurance companies to provide medical care to individuals who are eligible for Medicaid. You have the legal right to enroll in both Medicaid and a commercial health insurance plan, but that doesn't mean you necessarily have to. You are no longer eligible for a marketplace plan that provides a discount on your insurance premium through the use of an advance premium tax credit once it has been determined that you are eligible for Medicaid or any other health insurance that satisfies the requirement for coverage established by the Affordable Care Act (ACA). You will not see any reduction in your out-of-pocket expenses, either. In this scenario, you are required to also cancel any marketplace coverage that provides premium discounts or other cost savings for any member of your family who is enrolled in Medicaid or is eligible for Medicaid. If you cancel your Marketplace plan before getting the final word on whether or not you are eligible for Medicaid, you will not be able to re-enroll in that plan in the future. If you are unable to meet the requirements for special enrollment, you will be required to hold off until the next open enrollment period.In the Event That You Qualify for Both Medicaid and a Private Insurance Plan
Being qualified for Medicaid and a private insurance plan at the same time comes with a few advantages. When it comes to services that are covered by both programs, private insurance will pay first, and then Medicaid will pay the difference between your provider's permitted charge and the payment made by private insurance, up to the maximum amount that Medicaid will pay in your state. The typical requirements for copayments and deductibles in private health insurance coverage are as follows: It is possible that Medicaid will pay for these out-of-pocket payments on your behalf if you are eligible for both Medicaid and private insurance. Aside from working with other payers on a third-party basis, Medicaid may also arrange for commercial insurance plans and other entities to pay health care providers for services that are covered by Medicaid. This is in addition to working with other payers on a collaborative basis. The majority of Medicaid recipients receive at least some of their care through managed care plans that have direct contracts with the states. In most circumstances, if you are enrolled in Medicare (which is available to those aged 65 and older or, in some cases, younger people with disabilities), you will not be eligible for coverage through the health insurance marketplace. If, on the other hand, you already have a plan through the marketplace but are not enrolled in Medicare, you will be able to keep the plan through the marketplace even after your Medicare coverage begins. On the other hand, you should prepare yourself for the possibility of seeing a reduction in the premium tax credits or savings you've been getting from your marketplace plan.How Other Forms Of Coverage Interact With Medicaid
Even if you are covered by another health insurance plan, you may still be eligible for Medicaid due to the coordination of benefits laws, which determine which plan pays their portion of your medical expenses first. Your private insurance, whether it is obtained via Medicare or an employer-sponsored plan, will serve as the primary payer in this scenario. This means that it will pay your health care provider before any other insurance does. As secondary insurance, Medicaid will pick up the tab for anything that your primary insurance won't cover, up to the policy's maximum. If you are eligible for both Medicaid and private health insurance, you are required to present your medical provider with a copy of both your private health insurance card and your Medicaid card whenever you receive medical services. If a health care provider accepts your Medicaid card in addition to your card from a private insurance company, you won't be responsible for any copayments or deductibles. It is required that any money obtained from an insurance company or as compensation for a medical care lawsuit be used to compensate the health provider in question. If Medicaid has already paid a portion of the cost of care, you are required to pay back that portion to Medicaid. You can be qualified for participation in the Health Insurance Premium Payment (HIPP) program if the private insurance you have comes from a plan that is offered by your employer. If you or a member of your family are eligible for Medicaid coverage, you may be able to get assistance from the Health Insurance Premium Payment Program (HIPP), which is an optional program. If the provider of your service refuses to accept your Medicaid or private insurance card, your insurance company may be able to assist you in finding a doctor who participates in its network of providers.Questions That Are Typically Asked
Which option, having private insurance or Medicaid, is preferable?
If you compare Medicaid to private insurance in terms of what you get back, you will find that Medicaid offers more complete benefits at lower out-of-pocket expenditures than private insurance does. Because of lower administrative costs and higher payment rates made by the Medicaid program to health care providers, Medicaid has a lower overall cost per beneficiary.I already have health insurance through my employer; may I use Medicaid as a supplemental insurance policy?
Yes. You are able to use Medicaid as supplementary insurance in addition to the plan provided by your employer. Your employer's health insurance plan will make the initial payment to your healthcare provider, and then Medicaid will take over to cover any remaining costs.