If you have Medicare and Medicaid, there is a plan built for that
Most people who qualify were never told. And unlike most of Medicare, you may not have to wait until fall to change anything.
Peter Abilla · Licensed Medicare Insurance Sales Agent
Alabama, California, Ohio, Pennsylvania, Texas, Utah, New Jersey, New York, North Carolina, Michigan, and Illinois
Where would you like to start?
Read it front to back if you like. Or start with the line that sounds like you.
Nothing here needs deciding today. These plans are not a limited-time offer, and a good decision in March is better than a rushed one in November.
What is a plan for people who have both?
Some people have Medicare and Medicaid at the same time. If that is you, there is a kind of Medicare Advantage plan made specifically for your situation. The formal name is a Dual Eligible Special Needs Plan. Most people say D-SNP, said “dee-snip.”
It is one plan, not two
Your Medicare and your Medicaid both still exist. The plan is built to work with both instead of making you manage them separately.
You keep your Medicaid
Joining one of these plans does not end your Medicaid. It is not a trade.
Not everyone can join every plan
There are different levels of Medicaid. Which plans you can join depends on which level you have and which county you live in.
You usually have more chances to change
Most people on Medicare can only change plans in the fall. That is often not true for you.
Your situation will differ from your neighbor’s. Plans are approved county by county, so two people with the same cards can have different options.
How do I know if I have both?
Look at your cards.
Medicare is the red, white, and blue card. It comes from the federal government. If you have Part A and Part B, the card will say so.
Medicaid is a separate card from your state. In Utah it comes from Utah Medicaid. In Ohio, Pennsylvania, and Alabama it comes from that state’s program. Some states send a plastic card, some send a paper letter.
If you have both, you may qualify.
Some people have Medicare and get help paying for it without having full Medicaid. That is a different situation and it still may open up options. See the Extra Help section.
You do not need to bring me a number off either card. Just tell me which ones you have.
Do I have to wait until fall to change plans?
Probably not. This is the part almost nobody explains properly, so it is worth reading slowly.
Most people on Medicare can only change their plan between October 15 and December 7. If you have Medicaid or Extra Help, different rules apply to you.
The rules changed in January 2025. Before that, people with both could change four times a year. Now it works differently — and for some people, more often.
- If you have Medicaid or Extra Help. You may be able to make one change each month to your prescription drug coverage, instead of waiting for fall.
- If you have full Medicaid. You may also be able to join certain plans that combine your Medicare and your Medicaid into one plan. That is also once a month.
- Which one applies to you depends on two things. What level of Medicaid you have, and which plans are approved in your county. Those are the two questions, and both have short answers.
This is the single most useful thing to know about your situation: you probably have more chances to change than the people around you do. It also means there is never a reason to rush. If a plan is right in March, it will still be right in April.
The specific rule that applies to you is something worth confirming, not guessing. It takes about two minutes on the phone: 938-238-5652.
What if I get Extra Help but not full Medicaid?
Extra Help is a program that lowers what you pay for prescription drugs. Some people call it the Low Income Subsidy, or LIS.
Here is what surprises people: more people have Extra Help than have full Medicaid. You can have one without the other.
If you get Extra Help, you may be able to change your drug coverage once a month, even if you do not have full Medicaid.
And if your Extra Help just changed — you got a letter, or your amount went up or down, or it stopped — that change itself may open up options for you right now.
If you got a letter from Social Security or your state about Extra Help and you are not sure what it means, that is a normal thing to call about. Bring the letter. You do not need to understand it first.
What do these plans usually include?
This varies by plan and by county, so what follows is general.
Most of these plans include:
- Everything Original Medicare covers
- Prescription drug coverage built in
- Help coordinating care between your doctors
- Routine extras that Original Medicare does not cover, which commonly include dental, vision, and hearing
- A care coordinator or case manager, depending on the plan
Every one of those varies. Networks, drug lists, and extras change by plan, by county, and from year to year. The only way to know what is actually available where you live is to look it up for your ZIP code.
What about the grocery and utility cards?
You may have seen advertising about cards for groceries or help with utility bills. These are real, and they are also widely misrepresented.
Here is the honest version:
- Some plans offer them. Many do not.
- They are not part of Medicare. They are extra benefits some plans choose to offer.
- Not everyone in a plan gets them. They are tied to having specific documented health conditions.
- The amounts and the rules differ by plan and change each year.
If an advertisement makes it sound like everyone gets money for groceries, that advertisement is not being straight with you.
Grocery, utility, and similar allowances are special supplemental benefits for the chronically ill. Not all members will qualify. To be eligible, you must have a qualifying chronic condition, which may include diabetes, chronic heart failure, cardiovascular disorders, chronic lung disorders, or chronic kidney disease. Other conditions may also qualify. Even if you have one of these conditions, you may not receive the benefit — eligibility depends on meeting the chronic illness criteria and the plan’s own coverage requirements.
What happens if my Medicaid stops?
Medicaid eligibility gets reviewed. Sometimes it stops — because income changed, or because paperwork did not get returned in time.
If you are in a plan built for people with both and your Medicaid ends, you do not lose your Medicare. But your plan may no longer be the right fit, and there are usually rules that give you a window to make a change.
- If you get a notice, do not ignore it. Some Medicaid terminations are paperwork problems and can be corrected.
- Call someone before the window closes. There is usually a period where you can change plans because of the change in your Medicaid. It does not last indefinitely.
Your state Medicaid office handles the Medicaid side. I can help with the Medicare side. Those are two different phone calls and it helps to know which is which.
What should I ask before enrolling in anything?
Ask any agent these. Including me.
- How many plans do you represent in my county?
- Are my doctors in this plan’s network?
- Are my prescriptions on this plan’s drug list, and at what cost?
- Is my pharmacy in network?
- What happens to this plan if my Medicaid changes?
- What is not covered that I have now?
- What will I pay out of pocket in a normal month?
If an agent cannot answer question one, that tells you something.
What if someone contacts me out of the blue?
People with Medicare and Medicaid get targeted more than almost anyone else. It is worth knowing what is not allowed.
An agent or plan may not:
- Call you about a Medicare Advantage or drug plan if you did not ask them to
- Text you or send you a social media message you did not ask for
- Come to your door uninvited
- Ask you for your Medicare number in order to “check your eligibility”
- Offer you cash, or a gift card that works like cash, to sign up
- Tell you that you must decide today
If someone does any of these, you can hang up. You are allowed to hang up. You are also allowed to ask for their name, their agency, and their license number before you say anything else.
Your Medicare number belongs to you. Treat it like your Social Security number. A legitimate agent does not need it to answer a question about plans in your county — only your ZIP code and, eventually, your permission.
You can also get free, unbiased help that is not selling anything. Every state has a program called SHIP — the State Health Insurance Assistance Program. They do not sell plans. Call 1-800-MEDICARE and ask for your state’s SHIP.
Who wrote this?
Peter Abilla · Licensed Medicare Insurance Sales Agent
Resting Sycamore Advisors
Licensed in Alabama, California, Ohio, Pennsylvania, Texas, Utah, New Jersey, New York, North Carolina, Michigan, and Illinois
Insurance licenses: Alabama 3004331330 · California 4576435 · Ohio 1753385 · Pennsylvania 1323868 · Texas 3542255 · Utah 1123762 · New Jersey 3004401038 · New York 1993623 · North Carolina 22265186 · Michigan 22265186 · Illinois 22265186.
Last updated
Quoted on Medicare in Newsweek, NTD, and InsuranceNewsNet — as commentary, not endorsement.
Makaistorya ko og Binisaya.
My services are $0.00, forever. The carriers we represent compensate us, but my service to you will always be $0.00.
A first conversation is mostly questions. What cards you have, your doctors, your prescriptions, your county. Often the answer is that your current setup is already right, and I say so.
Want someone to look at this with you?
A real person, not a call center. If I am with someone, leave a message and I will call you back the same day.
Tell me your ZIP code and I will tell you what is actually available where you live.