There are many confusing issues associated with health insurance these days – Medicare and Medicaid are two prime examples of such issues. I, along with the dedicated staff of the Consumer Assistance division at the North Dakota Insurance Department, believe that you shouldn’t have to navigate these muddy waters alone. In this article, you will learn more about:

What the main differences between Medicare and Medicaid are;

Who to contact if you have questions about or need assistance with either program;

What are Medicare Savings Programs and how can they help with Medicare costs;

And finally, how the State Health Insurance Counseling (SHIC) program can assist you with your senior health insurance needs.

First, let’s begin by taking a closer look at how Medicare and Medicaid compare using the table on the right:

Some individuals may be able to be covered by both Medicare and Medicaid. These individuals are known as “dual eligible” beneficiaries. North Dakota has approximately 16,300 dual eligible beneficiaries, about 15 percent of all North Dakota Medicare beneficiaries according to the Kaiser Family foundation. To find out if you could qualify to be a dual eligible beneficiary, please contact your county Social Services office.

If you do not qualify for Medicaid, you may still find some assistance with your Medicare costs if you qualify for one of three different programs known as the Medicare Savings Programs. The Medicare Savings Programs (MSPs) are state programs that assist you with paying your Medicare costs. At the very least, if you qualify, your Part B premium would be paid for by the state, which means your monthly Social Security check will increase by the amount you currently pay for your Part B premium. You could have even more costs covered depending on your level of qualification. The programs may include premiums, deductibles, coinsurance charges and copayments. Each MSP has different federal income and asset eligibility limits. The three levels are:

1. Qualifying Individual (QI): QI pays for your Part B premium and provides three months retroactive Part B premium reimbursement from the month of application. Note: you cannot have Medicaid and QI.

2. Specified Low-Income Medicare Beneficiary (SLMB): SLMB pays for your Part B premium and provides three-month retroactive Part B premium reimbursement from the month of application. Note: you can have Medicaid and SLMB.

3. Qualified Medicare Beneficiary (QMB): QMB pays for your Part B premium and Medicare deductibles, coinsurance charges, and copayments. If you have a Medicare Advantage Plan, QMB pays for your plan’s cost sharing. The program also pays for your Part A premium if you do not qualify for premium-free Part A. It does not provide three months retroactive Part B premium reimbursements; benefits start the first of the month after the month you are approved for the program. Note: you can have Medicaid and QMB.

To verify your eligibility, a State Health Insurance Counselor can work with you to see if you might meet the income and asset limits. To apply for an MSP, you will need to apply to your local county Social Services Office.

For questions regarding Medicare, the SHIC program, through the North Dakota Insurance Department, can answer your questions and provide guidance. SHIC counselors are trained in all aspects of senior insurance issues, such as Medicare, Medicare prescription drug plans and Medicare Advantage plans. They can help you complete paperwork and understand statements, sort and reconcile bills, file claims or appeals, and educate you about supplemental coverage options and long-term care for the future. For assistance, contact SHIC at (888) 575-6611 or ndshic@nd.gov.

For more information about Medicaid, please contact your county Social Services office or the North Dakota Department of Human Services at (701) 328-7068 or toll-free at (800) 755-2604.