MEDICARE SERVICES

Understand how Medicare and Medicaid may work together.

People who qualify for both Medicare and Medicaid are often called dual eligible. Depending on eligibility, Medicaid may help with Medicare premiums or cost-sharing and may cover services Medicare does not.

Discuss your coverage

Older adult reviewing Medicare and Medicaid dual-eligible benefits with an advisor — Review Medicare and Medicaid benefits together, including eligible OTC allowances.

Coverage can vary by state and eligibility category

Help with Medicare costs

Medicaid and Medicare Savings Programs may help eligible people with Part A or Part B premiums and certain deductibles, coinsurance, or copayments.

Coordinated plan options

Some people qualify for a Dual Eligible Special Needs Plan (D-SNP), a type of Medicare Advantage plan designed to coordinate Medicare and Medicaid benefits.

OTC card benefits

Certain Medicare Advantage or D-SNP plans may offer an allowance for eligible over-the-counter health items. Covered products, participating stores, amounts, and rules vary by plan.

Other possible benefits

Depending on the state and plan, coverage may include transportation, dental, vision, hearing, care coordination, or additional support.

OTC cards are not a universal Medicaid benefit. They are usually plan-specific supplemental benefits. An allowance may expire, be limited to approved products, or require use through designated retailers.

Verify before enrolling or using a benefit

Confirm your current Medicaid eligibility and category with your state Medicaid agency.
Check whether your doctors, medications, pharmacies, and preferred hospitals participate.
Read the plan Evidence of Coverage for OTC and other supplemental-benefit rules.

Review represented options

Eligibility and benefits vary by state, county, income, resources, Medicaid category, plan, and plan year. Gala Health does not determine Medicaid eligibility and does not offer every plan available.

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TURNING 65 WITH MEDICAID

What to review when Medicaid members become eligible for Medicare

If you have Medicaid and are turning 65, contact your state Medicaid agency before your Medicare effective date. Ask whether the state will enroll you in Medicare Part A or Part B, whether your Medicaid category may change, and whether you qualify for help with Medicare premiums and cost-sharing.

Confirm Medicare enrollment

Your Medicare Initial Enrollment Period is generally the seven-month window surrounding your 65th birthday. Some people are enrolled automatically; others must apply.

Confirm Medicaid and Medicare Savings Program eligibility

Full Medicaid and Medicare Savings Programs are different levels of assistance. Eligibility, income limits, and covered costs vary.

Compare coordinated coverage carefully

If a D-SNP is available, compare its provider network, prescriptions, care coordination, dental, vision, transportation, food or utility benefits, and OTC allowance rules.

How OTC card benefits may work

An over-the-counter benefit card may allow eligible plan members to purchase approved health and wellness products, such as first-aid supplies or certain nonprescription items. Some plans use a catalog, online store, participating retailer network, quarterly allowance, or monthly allowance. Unused amounts may not roll over.

Before using an OTC card: verify the allowance amount, eligible products, approved retailers, expiration rules, and whether the benefit is combined with any food or utility allowance. These details are determined by the plan.

Turning 65 with Medicaid FAQs

Will Medicare replace Medicaid when I turn 65?

Not necessarily. People who qualify may have both programs. Medicare generally pays first for Medicare-covered services, while Medicaid may help with certain remaining costs and additional services.

Is every Medicaid member eligible for an OTC card?

No. OTC allowances are typically supplemental benefits from certain Medicare Advantage or dual-eligible plans and are not universal Medicaid benefits.

What is a D-SNP?

A Dual Eligible Special Needs Plan is a Medicare Advantage plan for people who meet applicable Medicare and Medicaid eligibility requirements.

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