Navigating Medicaid and Medicare for Individuals with Disabilities
For individuals with disabilities, accessing affordable healthcare is critical—but navigating the differences between Medicaid and Medicare can be confusing. Both programs offer important benefits, but they serve different purposes, have different eligibility requirements, and may work together in some cases. At American Disability Action Group, we aim to empower individuals in Arkansas, Oklahoma, Mississippi, Tennessee, Texas, and Louisiana with the knowledge they need to make informed decisions about their healthcare coverage.
What Is Medicare?
Medicare is a federal health insurance program primarily for people age 65 and older, but it also covers certain individuals under 65 who have qualifying disabilities. If you’ve been receiving Social Security Disability Insurance (SSDI) benefits for 24 months, you are automatically enrolled in Medicare, regardless of your age.
Medicare has four parts:
- Part A: Hospital insurance
- Part B: Medical insurance (doctor visits, outpatient care)
- Part C: Medicare Advantage (private plans that bundle Parts A and B)
- Part D: Prescription drug coverage
In Arkansas and other Southern states, Medicare provides consistent federal benefits, but individuals may also consider Medicare Advantage plans, which are administered through private insurers and can vary based on location.
What Is Medicaid?
Medicaid is a state and federally funded program that provides healthcare coverage to people with limited income, including individuals with disabilities. Unlike Medicare, Medicaid eligibility and services can differ significantly from state to state.
In Arkansas, Oklahoma, Mississippi, Tennessee, Texas, and Louisiana, Medicaid is available to individuals with disabilities who meet specific income and resource limits. Each state operates its own Medicaid program and may offer additional benefits such as personal care services, long-term care, or home- and community-based services (HCBS) waivers.
Key Differences
| Feature | Medicare | Medicaid |
| Administered By | Federal Government | Federal + State Governments |
| Eligibility | SSDI recipients (after 24 months), 65+ | Income/resource-based + disability |
| Cost | Premiums, deductibles, and copays apply | Often free or low-cost based on income |
| Coverage | Hospital, medical, drug coverage | Broad range, may include long-term care |
| Availability | Same across U.S. | Varies by state |
Dual Eligibility
Some individuals may qualify for both Medicaid and Medicare, often referred to as “dual eligibles.” In these cases, Medicare typically serves as the primary insurer, and Medicaid helps cover out-of-pocket costs like premiums, deductibles, and copayments. For residents of Tennessee or Texas, being dual eligible may also open access to special programs like Medicare Savings Programs (MSPs) or integrated care plans.
Why This Matters in Your State
In states like Oklahoma and Mississippi, access to Medicaid expansion has been evolving, potentially offering more coverage options. In Louisiana, Medicaid offers strong HCBS options for people with disabilities. In Texas, where Medicaid eligibility rules remain strict, it’s especially important to understand income and asset limits to maintain or qualify for benefits.
Get Help Navigating Your Options
Whether you live in Arkansas, Oklahoma, Mississippi, Tennessee, Texas, or Louisiana, understanding the distinctions between Medicare and Medicaid—and how they may work together—is essential for accessing the care you need. Our Arkansas & Nationwide Attorneys at American Disability Action Group help individuals with disabilities understand their healthcare rights and guide them through the process of applying, maintaining eligibility, or appealing denials.