Medicare Frequently Asked Questions (FAQs)

The Indian Health Service (IHS) is a federal program that delivers health care to American Indians and Alaskan Natives (AI/ANs).

Clients who receive services through Indian Health Services networks may continue to do so once they enroll in Medicare, so they should enroll in Medicare when they become eligible. The IHS providers serving Medicare enrollees may bill Medicare for services provided.

TRICARE is the uniformed services health care program for active-duty service members, active-duty family members, National Guard and Reserve members and their family members, retirees and retiree family members, survivors, and certain former spouses.

Individuals who are enrolled in TRICARE do not have to enroll in Medicare, and will not be charged a penalty for not doing so.

If a client is eligible for both Medicare and TRICARE, they may enroll in Medicare and will continue to automatically receive TRICARE coverage. Medicare will be the client’s primary payer and TRICARE can cover cost sharing (e.g., coinsurance and deductibles) and services not covered by Medicare. 

The Veterans Administration (VA) is an integrated health care system that offers a range of health care services to uniformed service members and veterans.

Individuals who receive VA services do not have to enroll in Medicare, and will not be charged a penalty for not doing so.

If a client is eligible for both Medicare and VA benefits, they are able to receive care under either program. However, the client must choose which program to use. For instance, if the client wants to use VA services, they must go to a VA facility or seek authorization from the VA to go to a non-VA facility. Medicare does not pay in this scenario. If the client goes to non-VA providers to seek care, then they may use their Medicare coverage.  

Because Medicaid renewals and redeterminations were suspended during the COVID-19 pandemic, there may have been clients who turned 65, but remained on Medicaid instead of enrolling in Medicare. These clients may be eligible for a new Special Enrollment Period that will allow them to enroll in Medicare without a penalty if they lose Medicaid coverage after January 1, 2023. Clients have six months from the date their Medicaid coverage ends to enroll.

Assess the client’s eligibility to remain on Medicaid once they turn 65. State Medicaid programs may have different eligibility criteria depending on age.

As long as the client meets the eligibility criteria for both Medicaid and Medicare (also known as dual eligibility), they are able to receive coverage from both programs. A few common scenarios may include:

• If the client was eligible for Medicaid under the Affordable Care Act (ACA) Medicaid expansion group (i.e., individuals up to 138% of federal poverty level), that coverage ends when the client turns 65 and they transition to Medicare. However, the client may still be eligible for other Medicaid eligibility categories in addition to Medicare and will be reassessed for other Medicaid eligibility categories before they turn 65. (Note: this process was different during the COVID-19 pandemic when Medicaid programs were prohibited from terminating coverage, see the question below for more information). The client may also be eligible for a Medicare Savings Program, where Medicaid can help pay for their Medicare premium and reduce their cost-sharing obligations. 
• If the client is under 65 and enrolled in Medicaid based on another eligibility category (e.g., disability), and then becomes eligible for Medicare when they turn 65, they may continue to be eligible for full Medicaid coverage (depending on the state) in addition to being eligible for Medicare. Some state Medicaid programs end Medicaid coverage at age 65, and clients should check in with their state Medicaid programs to understand eligibility rules. Dually eligible clients may be entitled to some Medicaid services that Medicare does not cover. As stated above, even if the client is no longer eligible for another full Medicaid eligibility category, they may still be eligible for a Medicare Savings Program to help with Medicare costs. If a client was enrolled in Medicaid and Medicare and subsequently loses Medicaid coverage, they are eligible for a Special Enrollment Period to pick a Medicare Advantage plan or to enroll in traditional Medicare. This is because they will no longer be eligible for a specific type of Medicare Advantage plan only available to dually eligible enrollees called a Dual Eligible Special Needs Plan (D-SNP).