Frequently Asked Questions

Get answers to FAQs for people with Medicaid and Medicare.

Medicare is a national health insurance program run by the federal government. It’s for people age 65 and older, and also some people under age 65 with certain disabilities. Learn more about Medicare. 

UnitedHealthcare health plans are offered by United Healthcare Insurance Company and our affiliates. We (and other private insurance companies) work with federal and state agencies to provide government-sponsored health insurance. We are not part of Medicare. We work with the Centers for Medicare & Medicaid Services (CMS) and many state governments to provide health coverage for Medicare and Medicaid recipients. Learn more about Medicare

Medicare Advantage plans (also known as Medicare Part C) offer an alternative to Original Medicare (also known as Medicare Parts A and B). You will get your Part A and Part B benefits through your Medicare Advantage plan. Most Medicare Advantage plans also include Part D prescription drug coverage, as well as other benefits such dental, vision, hearing and fitness. They often (but not always) include a specific network of doctors and health care providers you can use to get care, sometimes at lower costs than with other types of health plans. Learn more about eligibility for Medicare Advantage plans. . Learn more about eligibility for Medicare Advantage plans

Medicaid is a federal and state program that provides health care coverage to people who qualify. Each state runs its own Medicaid program, but the federal government has rules that all states must follow. The federal government also provides at least half of the funding for their Medicaid requirements. Learn more about what Medicaid is and what Medicaid covers.

In all states, Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states, Medicaid covers all low-income adults below a certain income level.

The exact requirements to qualify for Medicaid depend on where you live. To find out if you're eligible for Medicaid in your state, visit the website for Medicaid in your state. Then check the eligibility requirements.

You'll find a link to the website for your state Medicaid agency on the "Plan Details" page for each health plan UnitedHealthcare Community Plan offers. To see the plans available in your area, please use the search feature on our home page at UHCCommunityPlan.com

When you apply for Medicaid, you'll need to fill out an application form. Different states have different requirements for Medicaid. You'll likely need to have various documents, such as:

Personal information

  • Information about household members (name, date of birth and Social Security number)
  • Proof of citizenship

Financial information

  • Rent or mortgage information
  • Expenses (utilities, daycare, etc.)
  • Vehicle information
  • Bank statements
  • Income (pay stubs)

Medical information

  • Proof of disability or medical records showing a lasting medical condition
  • Recent medical bills

You'll need to apply through the state agency that manages the Medicaid program in your state. For questions, or to see what health plans UnitedHealthcare Community Plan offers in your area, please use the search feature on our home page at UHCCommunityPlan.com.

Each state manages its own Medicaid program so what’s covered by Medicaid can change from state to state. But there are some services that every state must cover in their Medicaid program by federal law. These are called mandatory benefits. States can also choose to offer other benefits under Medicaid. These are called optional benefits.

Mandatory Medicaid benefits include:

  • Inpatient hospital care
  • Inpatient short-term skilled nursing or rehabilitation facility care
  • Doctor services
  • Outpatient hospital or clinic care
  • Laboratory and X-ray services
  • Short-term home health care (provided by a home health care agency)
  • Ambulance service
  • Prescription drugs for people not covered by Medicare

Optional benefits offered by some states may include:

  • Eye exams and glasses
  • Hearing tests and hearing aids
  • Dental care
  • Preventive screenings
  • Physical therapy (beyond what is offered under Medicare)
  • Non-emergency transportation to and from medical treatment
  • Some prescription drugs not covered by Medicare
  • Some nonprescription drugs, including certain vitamins
  • Chiropractic care

In most cases, Medicaid is the payer of last resort. That means that Medicaid will pay after any other payer has paid its share of the services provided. For example, if you have Medicare or any type of private health care coverage, Medicaid will always be the secondary payer. Health care providers will bill the primary payer first, and Medicaid will pay what’s left over. That’s why Medicaid enrollees must say if they have other sources of coverage.

Medicaid is a health care program that's managed at the state level by each state government. However, state governments do not actually provide health insurance. State governments contract with private insurance companies like UnitedHealthcare to provide health coverage for beneficiaries of Medicaid and other government health care programs. Our government-sponsored health plans operate under the name UnitedHealthcare Community Plan.

In most cases, Medicaid pays the full cost for covered services, so people with Medicaid do not have to pay a monthly premium or any deductibles. But there are some exceptions and rules vary by state. In certain cases, if someone has Social Security benefits, a small amount may be taken from those benefits to help cover the cost of Medicaid coverage.

Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is funded jointly by states and the federal government. Medicare is a federal program. It provides coverage for people age 65 and older, and also some people under age 65 who qualify due to a disability. Learn more about the difference between Medicaid and Medicare

Yes. Some people qualify for both Medicare and Medicaid. These people qualify for Medicare due to age (by being age 65 or older) or because they have a disability. They also qualify for Medicaid because they meet the Medicaid requirements in their state. People who are eligible for both Medicare and Medicaid are "dual eligible." Learn more about having both Medicare and Medicaid.

Medicare and Medicaid are two separate programs that have different eligibility requirements.

To qualify for Medicare, you need to be:

  • At least 65 years old, or you’re under 65 and qualify on the basis of disability or other special situations
    AND
  • A U.S. citizen or a legal resident who has lived in the U.S. for at least 5 years in a row

To qualify for state Medicaid benefits, you need to be:

  • Under age 65 and meet the requirements for low-income families, pregnant women and children, individuals receiving Supplemental Security Income (SSI), disability or other special situation
  • At least 65 years old and you also:
  • Receive Extra Help or assistance from your state
  • Are blind or have a disability, but do not need long-term care

As part of the Affordable Care Act, most states chose to expand Medicaid coverage to include all low-income adults under age 65. Other states may choose to do so at any time. Many people are surprised to find out they qualify. That's why it's always good to check.

To see if you're eligible for Medicaid in your state, visit the website for Medicaid in your state. Then check the eligibility requirements.

The Affordable Care Act created a new office within the Centers for Medicare & Medicaid Services (CMS). The Medicare-Medicaid Coordination Office makes sure people who are dually enrolled in both Medicare and Medicaid have full access to seamless, high quality health care. The goal is to make the two programs work together more effectively to improve care and lower costs.

Medicaid programs can help Medicare by paying certain Medicare costs. And by covering benefits not offered by Medicare, such as hearing, transportation, vision, dental and long-term care.

Dual special needs plans (also called dual health plans or D-SNPs for short) are for people who qualify for both Medicare and Medicaid. A dual health plan works together with your Medicaid health plan. You’ll keep all your Medicaid benefits. Dual health plans cover eligible doctor visits, hospital stays and prescription drugs.1 For people who qualify, a dual health plan may offer more health benefits than with Original Medicare and a separate Part D plan.

Dual health plans:

  • Are designed for people who may need extra help because of disabilities, age and/or health conditions
  • Provide more benefits than Original Medicare1
  • Are offered by private insurance companies like UnitedHealthcare
  • Come with no additional costs

1Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply.

(Even if you do have a premium — that’s the amount you pay for insurance — you may qualify for low-income subsidies to help with the cost.) Learn more about dual special needs plans. 

"Dual eligible" describes people who qualify for both Medicare and Medicaid at the same time. These people are eligible for both programs, so they’re "dual eligible."

As of January 1, 2020, dual special needs plans no longer have an unlimited special enrollment period. There’s an ongoing Dual Special Enrollment Period (SEP) for the first 9 months of the year. People who qualify can enroll or change plans once every 3 months. Enrollment changes will be effective the first day of the next month.

NOTE: It's important to remember that to stay eligible for a dual health plan, you must recertify for Medicaid every year. As long as you stay eligible, your dual health plan will renew automatically each year. Learn more about dual plan enrollment

Dual health insurance plans offer benefits and services not typically available through Medicare or Medicaid. With a dual health plan, you'll keep your Medicaid benefits, and you’ll get more benefits than Original Medicare with as low as a $0 premium. UnitedHealthcare dual health plans include a wide range of extra benefits and features.1

Our plans may cover:

  • Routine dental care
  • Credits to buy hundreds of health products
  • Eye exams, plus credit for eyewear
  • Hearing exams, plus credit for hearing devices
  • And more

1Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply.

Some dual health plans also include care coordination. That's a big help — especially for people who have complex medical needs. It makes it easier to manage your doctors, specialists and care services. Learn more about dual health plan benefits

Please note that the dual plans UnitedHealthcare offers, and the specific benefits they include, can change depending on where you live. For details about the dual plans available in your area, please use the search feature on our home page at UHCCommunityPlan.com

Our dual plans typically cover preventive care and routine services at no extra cost to you. We also offer help with coordinating Medicaid benefits. Other standard benefits that are usually covered by our dual plans include:

  • Dental
  • Vision
  • Hearing
  • Transportation assistance
  • Nursing hotline]
  • And many other benefits and features1

1Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply.

1. Do you get state Medicaid benefits? (If so, you’ll have a state Medicaid card.)

You are under age 65 and meet the requirements for low-income families, pregnant women and children, individuals receiving Supplemental Security Income (SSI), disability or other special situation.

  • You are at least 65 years old and you also:
  • Receive Extra Help or assistance from your state
  • Are blind or have a disability, but do not need long-term care

2. Do you have Medicare Parts A and B?

  • You’re at least 65 years old, or you’re under 65 and qualify on the basis of disability or other special situations
    AND
  • You're a U.S. citizen or a legal resident who has lived in the U.S. for at least 5 years in a row

3. Do you live in an area where dual plans are available?

A UnitedHealthcare licensed sales agent can tell you if you live in our service area. Or, to see the plans available in your area, please use the search feature on our home page at UHCCommunityPlan.com.

4. Do you meet the health requirements?

Most likely, you won’t be able to qualify for a dual plan if you have end-stage kidney failure, also called end stage renal disease (ESRD). If that’s the case, please talk with a UnitedHealthcare licensed sales agent to discuss your specific situation.

If you're enrolled in a UnitedHealthcare dual plan and you lose your Medicaid eligibility, we'll put you on hold for 6 months. During this time, you'll have to pay the Medicare cost-sharing portion such as copayments, coinsurance, deductibles and premiums. If you don't regain your Medicaid eligibility at the end of the 6 months, you’ll be unenrolled from our dual plan.

But remember, you can enroll in a dual plan at any time. If you get your Medicaid coverage back, just talk with a UnitedHealthcare licensed sales agent to re-enroll in a dual plan.

No. Referrals are not needed to get care from any in-network doctors, hospitals or clinics.

See UnitedHealthcare plans in your area.

Please note: What dual-eligible plans you can get depends on where you live. To find a UnitedHealthcare Dual Complete® plan for you, please search plans in your state. 

Still Have Questions?

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Contact us at:
1-844-812-5967
TTY: 711

8 a.m. to 8 p.m. local time, 7 days a week.

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