Will I Qualify for Medicaid If I Have Health Insurance Also?

Medicaid -- a state-administered federal health care program -- uses a range of requirements to establish eligibility. However, having private or group insurance is not one of them. States determine the amount Medicaid will pay and what services are covered based on individual circumstances including your income and other qualifying information. Apply for Medicaid at a local Department of Health and Human Services office or your state equivalent.

Medicaid Eligibility

• Medicaid provides health care coverage to United States citizens and legal aliens. Dependent on state laws, you may be considered eligible under a specific group to qualify. Groups may include elderly and disabled individuals, pregnant women and children. In some states, very low-income able-bodied adults may qualify for benefits as well. State-determined income and asset limits apply, and benefits may be retroactive up to the three months preceding your application.

Private and Group Insurance

• Individuals with private or group health insurance qualify for benefits if they meet all other Medicaid requirements. In the case of dual coverage, your private health insurance is the primary provider and Medicaid pays for excess costs or procedures not covered by your health insurance. To ensure Medicaid pays for extra costs, show both insurance cards when obtaining medical care. If you are enrolled in a cost-sharing Medicaid plan, you may be responsible for applicable co-pay fees.

Medicare and Medicaid

• The Qualified Medicare Beneficiary Program helps with prescription fees, deductibles, premium costs and co-insurance payments for Medicare Part A recipients if the household income is at or below 100 percent of the Federal Poverty Level. Medicare members with incomes between 100 and 120 percent of the FPL receive Medicare Part B premium assistance and help with qualifying prescription costs. Individuals with incomes between 120 and 135 percent of the FPL qualify for Medicare Part B premium aid. Disabled working adults may receive Medicaid coverage for Medicare Part A premiums if their income does not exceed 200 percent of the FPL.

Considerations

• Medicaid provides coverage to individuals who do not qualify for benefits due to income if they are medically needy and have high medical bills. With medically needy coverage, income eligibility is determined after deducting applicable medical costs. Regardless of private health insurance, a medical provider is not required to take Medicaid as a form of payment. It is the Medicaid recipient's responsibility to find out if a doctor, hospital or other service provider accepts Medicaid.