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What Medical Benefits Do I Receive?

Medicaid and Medicare

Medicaid and Medicare are public benefits which offer healthcare coverage. They may also pay for items and services which help people live with greater independence.

Both benefits have a connection with Social Security cash benefits, though it is not necessary for you to have a cash benefit to be eligible for these medical benefits.

You can receive both Medicaid and Medicare at the same time.

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Comparing Medicaid and Medicare

Medicaid

  • Medicaid provides healthcare coverage. It also can pay for therapies, assistive technology, and services you may need to live independently at home and in your community.
  • Medicaid is connected to SSI. Like SSI, Medicaid is means-tested, which means it has rules on how much income and resources you can have. There are exceptions to these rules. In WA, there are different pathways to become eligible for Medicaid, and some have fewer or no restrictions.
  • Medicaid is funded through a partnership between the state and the federal government. Not all states offer Medicaid.
  • In Washington State, Medicaid is branded as “Apple Health.” You may also know it as “Provider One,” which is written on the Medicaid card.

Medicare

  • Medicare is our nation’s health insurance. It has three core parts which cover certain healthcare costs. Part C is an optional program.
  • Part A: Hospital
  • Part B: Medical
  • Part C: Advantage Plans
  • Part D: Prescription Drugs
  • Medicare is connected to Title II benefits:
  • Social Security Disability Insurance (SSDI)
  • Social Security Childhood Disability Beneficiary (SSCDB)
  • Social Security Disabled Widow’s/Widower’s Beneficiary (SSDWB)
  • Social Security Retirement Benefits
  • Title II spousal and survivor’s benefits.
  • Medicare is a federal program.

What medical benefits do I receive?

Here are some ways to identify what medical benefits you receive. You may need to read through a few of these clues to understand what you are eligible for.

1. Both Medicaid and Medicare issue you a card. Which card(s) do you receive?

Medicaid (Apple Health)

An example of a WA Services Provider One card.

Medicare

An example of a Medicare Health Insurance card.

If you are eligible for Apple Health, you must enroll in a health plan. A clue that you have Apple Health is that you also received an insurance card from one of the following health plans. (This list is subject to change.)

  • Community Health Plan of Washington
  • Coordinated Care of Washington
  • Molina Health care
  • UnitedHealthcare Community Plan
  • Wellpoint Washington

2. You can contact the government agency that manages these benefits and ask

Medicaid (Apple Health)

  • Medicaid: call the Apple Health Customer Service Center at 1-800-562-3022.

Medicare

  • Sign up for a mySSA account. There, you can log in and see what benefit(s) you are eligible for, including Medicare. Because Medicaid is managed by the state, you will not see information about Medicaid eligibility.

    You can also contact Social Security at 1-800-772-1214. Setting up a mySSA account may be faster than calling and waiting to speak with a claims representative.

3. Do you receive cash benefits?

It is not necessary to receive a public cash benefit to be eligible for Medicaid or Medicare. However, if you do receive a cash benefit, it can help you identify what medical benefit you receive.

  • SSI: If you receive SSI, you are automatically eligible for Medicaid in Washington State.
  • SSDI, SSCDB, DWB: If you have been eligible for these disability-related Title II benefits for at least two years, you may be eligible for Medicare.
  • Social Security Retirement benefits: you may receive Medicare when you turn age 65.

4. Do you receive support services, like in-home care or employment support?

  • Washington State pays for many support services for people through Medicaid. In-home care, therapies, employment assistance, and support with exploring your community are all examples of services paid for through Medicaid. If you receive any of these types of services, you may be eligible for Medicaid.
  • Medicare’s primary focus is healthcare. It can pay for some therapies and services, but they are limited and typically related to healthcare needs.
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