When helping clients with Medicare Supplement (Medigap) applications, you’ll often see a question about whether they are covered by medical assistance through their state Medicaid program. This question is crucial because having both Medigap and Medicaid coverage is tightly regulated.
When Is It Legal to Have Both Medigap and Medicaid?
There are only two situations where it’s legal for someone to have both a Medigap policy and Medicaid coverage:
- Medicaid Pays for the Medigap Policy:
In some states, Medicaid may cover the cost of the Medigap plan itself on behalf of the beneficiary. - Medicaid Only Pays the Part B Premium:
Sometimes, Medicaid covers only the Medicare Part B premium, while the individual holds a Medigap policy for additional coverage.
When Is It Illegal?
Outside of these two exceptions, it is illegal to have both Medigap and Medicaid coverage simultaneously. This is because the two programs generally cover overlapping benefits, and dual coverage could lead to improper payments or fraud.
What Should You Do?
Always make sure clients answer the Medicaid question accurately on their Medigap application. If you have questions about specific cases or state rules, it’s best to consult official resources or your carrier’s guidance.
Understanding these important distinctions helps ensure compliance and prevents complications for your clients.
Contact National Insurance Markets for more information.
