Do You Lose Medicaid with Medicare Advantage?
How Medicaid Works with Medicare
When you sign up for Medicare, you do not lose your Medicaid; in many states, enrolling in Medicare on time is actually required to keep your Medicaid benefits. Medicare becomes your primary health coverage, paying most medical claims first, and Medicaid acts as secondary coverage to help with remaining costs that Medicare does not fully cover. In many cases, if you qualify for full Medicaid or a Medicare Savings Program, your state helps pay your Medicare Part B premium.
What Does “Dual Eligible” Mean?
A dual eligible individual is someone who has both Medicare and Medicaid at the same time. Most people who are dual eligible also qualify for a Dual Special Needs Plan (D-SNP), which is a type of Medicare Advantage plan designed specifically for those who have both Medicare and Medicaid. These plans are built to coordinate your Medicare and Medicaid benefits and often provide additional services and savings tailored to dual eligible members.
What Is a Medicare Advantage Plan?
Medicare Advantage (Part C) plans are offered by private insurers approved by Medicare and combine your hospital (Part A) and medical (Part B) coverage, and usually prescription drug coverage (Part D), into one plan. Many Medicare Advantage plans also include extra benefits that original Medicare does not cover, such as dental, vision, hearing, fitness programs, and over-the-counter allowances.
When you enroll in a Medicare Advantage plan, it becomes your primary Medicare coverage, and Medicaid remains secondary to help with costs that are left over. You do not lose Medicare or Medicaid when you do this—the plan is required to cover everything Original Medicare covers, and may add extra benefits on top. To continue qualifying for a Dual Special Needs Plan or other dual-eligible Medicare Advantage options, you must keep both your Medicare and Medicaid active.
Are the Benefits Free?
Many Medicare Advantage plans that serve dual eligible members have a $0 monthly premium, which is one reason they are so popular for people with both Medicare and Medicaid. Any additional benefits offered by the plan are available to members at no additional cost making it a valuable option for DSNP enrollees.
Extra Benefits You Might Receive
You may see advertisements or social media posts about “food cards,” help with utility bills, or other living-expense benefits, and these can sometimes be offered through certain dual eligible Medicare Advantage plans. Eligibility for these extra benefits depends on your plan, your level of Medicaid, and where you live, but they are designed to support people on a limited or fixed income.
Common extra benefits on dual eligible plans can include:
Healthy food cards, utility assistance and, in some cases help with rent or mortgage payments through Special Supplemental Benefits for the Chronically Ill.
Expanded dental, vision, and hearing coverage with higher annual allowances to reduce out-of-pocket costs.
Transportation to medical appointments, over-the-counter (OTC) allowances for items like vitamins and cold medicine, and fitness memberships with participating gyms.
Understanding HMO vs PPO
While Medicare Advantage can offer strong value for dual eligible beneficiaries, it is important to understand the plan’s network rules before enrolling. The two most common network types are HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization), and both are used widely in Medicare Advantage and D-SNP plans.
In an HMO, you generally must see doctors and providers in the plan’s network, and you may need referrals from your primary care provider to see specialists.
In a PPO, you have more flexibility to see out-of-network doctors who accept the plan, but you may pay more to do so, even if you are dual eligible.
If you are fully dual eligible, your Medicaid benefits remain the same when you join a D-SNP plan as long as you stay within the plan's network, your medical costs are typically $0 or very low (aside from non-covered services). Before enrolling, it is important to confirm that your preferred doctors, hospitals, and prescriptions are covered so you can avoid disruptions in care.
Can I Have Medicare and Medicaid Without an Advantage Plan?
Yes. You can choose to keep Original Medicare and Medicaid without enrolling in a Medicare Advantage plan.
However, because plans and benefits change over time, it is still wise to review Medicare Advantage and D-SNP options regularly to see if a plan could offer you better coverage, extra benefits, or more coordinated care while keeping your costs low.
How Prescription Drug Coverage Works
If you have both Medicare and Medicaid, you are automatically enrolled in a Part D prescription drug plan. Most Medicaid enrollees also qualify for the Low-Income Subsidy (LIS), also known as Extra Help. This program significantly reduces or eliminates your Part D premiums, deductibles, and copays, which is especially important for dual eligible beneficiaries with regular prescriptions.
If you enroll in a Medicare Advantage Prescription Drug (MAPD) plan, your drug coverage is built into the plan, and Extra Help continues to apply as long as you remain eligible. That means you keep receiving prescription assistance even after switching from a stand-alone Part D plan to a MAPD.
Why Reviewing Your Coverage Every Year Matters
Every year from October 15th to December 7th, Medicare’s Annual Enrollment Period allows you to review and change your Medicare Advantage or Part D coverage for the upcoming year. Because Medicare Advantage and D-SNP plans can change premiums, networks, and extra benefits each year, dual eligible members can often improve their coverage or reduce costs by comparing options regularly.
Taking a little time each fall to review your current plan against the new plans in your ZIP code can help you avoid surprises, take advantage of new benefits, and potentially save hundreds of dollars for the coming year.