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Using Medicaid with Medicare or Other Medical Insurance

Using Medicaid with Medicare or Other Medical Insurance

If you have both Medicare and Medicaid, they work together for you. Medicare pays first, and Medicaid pays last.

Medicare has two parts that will pay along with your Arkansas Medicaid coverage: Medicare Part A and Medicare Part B.

Medicare Part A:

  • Pays for skilled nursing care and hospital services.
  • Pays for most of your hospital expenses.

Medicaid will pay most of the hospital bills that Medicare Part A doesn’t pay. You may be billed for a small amount, called “co-insurance.” You might also have to pay part of the deductible for inpatient hospital care.

Medicare Part B:

  • Pays for visits to the doctor.
  • Pays for lab tests and x-rays.

Not everyone on Medicare has Part B. You have to pay a small amount each month. Medicaid will pay this monthly charge for you. Let your DHS county office know you have Medicare Part B so you won’t be charged a Medicare premium. Medicaid also pays most of the charges that Medicare Part B will not pay. You may be billed for a small amount.

Medicare Part D:

Due to a change in federal law effective January 1, 2006, Arkansas Medicaid is no longer allowed to cover prescription drugs for persons who are dually eligible, having both Medicaid and Medicare prescription drug coverage. Medicare now pays for the prescription drugs for the dual eligible under Medicare Part D. For questions regarding Medicare Part D, you can call 1-800-Medicare (1-800-633-4227) or go to (HTML, new window).

If you have health insurance and Medicaid:

  • You must use your other insurance before Medicaid will pay.
  • Medicaid does not pay co-payments to other insurance.
  • Your doctor or other health care provider must bill your other insurance before billing Medicaid.
  • When you show your Medicaid ID card, you must also tell the doctor or other health care provider the name of your other insurance company and your insurance number. (You should have a card from your other insurance company that has this information.)
  • Medicaid might not pay anything after your insurance pays.
  • Your doctor or health care provider can choose not to bill Medicaid. Before you receive care, always ask if Medicaid will be billed.

Other times when Medicaid will not pay until someone else pays:

  • If you are hurt in a car accident, Medicaid will not pay until your car insurance or the other driver’s car insurance has paid or denied payment.
  • If you are hurt on the job, Medicaid will not pay until workers’ comp has paid or denied payment.
  • If you win a lawsuit because you got hurt or you get a cash settlement from such a lawsuit, you must use the money to pay your bills. Medicaid will only pay toward any amount left over.