How Medicare and Medicaid work together in Maryland
"I got a letter from Medicaid and a different one from Medicare. Which one do I follow?" We hear some version of this every week. The short answer is both, because they do different jobs. Once you see who does what, the paperwork gets much less confusing.
Medicare first, Medicaid second
Medicare is a federal program for people who are 65 or older, or who have certain disabilities. Medicaid is a joint federal and state program that helps people with limited income and resources. In Maryland, Medicaid is run by the Maryland Department of Health. When you have both, Medicare usually pays first. Medicaid may then pay some or all of what Medicare leaves behind, such as premiums, deductibles and copays, depending on the program you qualify for.
| What it does | Medicare | Maryland Medicaid |
|---|---|---|
| Hospital stays and doctor visits | Pays first, with deductibles and copays | May help with your share, depending on your program |
| Prescription drugs | Through Part D or an Advantage plan | May add support, and Extra Help may apply |
| Ongoing help with daily living | Generally not covered | May help for people who qualify |
| Who decides if you qualify | Social Security and Medicare rules | Maryland Medicaid |
Full benefits and partial help
"Dual eligible" is not one single thing. Some people have full Medicaid benefits. Others get partial help, such as a Medicare Savings Program that pays part or all of the Part B premium. Which one applies depends on income and resources, and the limits are reviewed every year, so we do not guess at them here. Our page on Extra Help and Medicare Savings Programs explains the help that may be available and how to apply.
Where long-term care fits
Many families in Baltimore end up learning this the hard way. Medicare pays for skilled care for a limited time after a hospital stay, but it generally does not pay for ongoing custodial help such as bathing, dressing or supervision. Maryland Medicaid may help with some long-term care for people who qualify, including programs designed to keep people at home or in community settings. Program names and rules change, so we point people to Maryland Medicaid for the current details.
If you are looking at adult day programs, the local health resources page lists two Baltimore centers. Original Medicare generally does not cover adult day care, and some Advantage plans offer related benefits.
Your Medicare choices when you also have Medicaid
Having Medicaid does not lock you into one type of coverage. You can:
- Keep Original Medicare and add a Part D drug plan. Medicaid may help with your costs.
- Join a D-SNP, a Medicare Advantage plan for people with both programs. See our guide to dual eligible and D-SNP plans.
- Join a standard Advantage plan, which we cover in our guide to Medicare Advantage in Baltimore City.
Help across the city
Whether you live in Old West Baltimore, Northwest Baltimore or near Pimlico, the steps are the same. Gather your cards, write down your doctors and medications, and make a list of the letters you have received. This city has been home to a large Black community for generations, and families here often help each other sort through paperwork. We are happy to include a son, daughter or friend on the call, with your permission.
What we can and cannot do
We can explain the programs, compare the Medicare plans we represent and help you enroll in one. We cannot decide who qualifies for Medicaid, and we are not a government or nonprofit counseling office. We are independent, licensed brokers paid by insurance companies, and our help is free to you.
Final thoughts
You do not have to figure out two programs on your own. Bring your letters and your questions, and we will go through them one at a time. There is no pressure and no obligation.
Get answers to your Medicare questions >>>
Or call (410) 896-1212 and speak with a licensed member of our team.
Related guides
Medicare Advantage in Baltimore City
Networks, extra benefits and yearly costs, explained.
Read more →Extra Help and Medicare Savings Programs
Programs that help with premiums and drug costs.
Read more →