Will Medicaid Cover My Co-Pay As Secondary Insurance?

If you have private insurance or your employer offers insurance through your job, you may find it a challenge to pay the co-pays and deductibles. Qualified low-income individuals and families may be able to use Medicaid as a secondary insurance to cover insurance premiums, deductibles or co-pays.

Medicaid Overview

Medicaid is the government-funded health insurance program administered in each state. Both the name of the program and its requirements vary by state. Each state is required to abide by certain eligibility criteria, such as the income limits for specific groups. In all states, Medicaid is open to pregnant women, children up to 18 years of age, parents or guardians with children living in the household, adults over age 65 and disabled individuals.

Medicaid as a Secondary Insurance

Whether Medicaid will cover as secondary insurance varies depending on the state's guidelines. There are no federal requirements for Medicaid to cover private insurance co-pays or deductibles. California uses funds from the Medi-Cal and Children's Health Insurance Program (CHIP) programs to help people who are eligible for employer-sponsored health coverage but who cannot afford to pay premiums. In Texas, the Texas Health Insurance Premium Payment program (HIPP) is designed to help Medicaid-eligible individuals pay their private insurance. To qualify for the HIPP program, at least one household member must be receiving Medicaid.

Medicare and Medicaid

In all states, Medicaid can be used as a secondary insurance for Medicare recipients. Disabled individuals or seniors who fall within the specified income guidelines can receive help with their deductible and co-pays from Medicaid. Supplemental Security Insurance (SSI) beneficiaries are automatically eligible for Medicaid coverage. Medicaid may also cover some services that Medicare does not cover. If you decline Medicare Part D, you will need to contact your Medicaid office to determine what steps you need to take to keep coverage.

Medicaid COBRA

The Consolidated Omnibus Budget Reconciliation Act (COBRA) provides an option for people who lose their job and want to remain on the company's heath insurance plan. The former employee is responsible for paying all premiums. Medicaid will sometimes pay the premium if you cannot afford it. For example, New Hampshire's HIPP program covers COBRA premiums and extensions. COBRA benefits typically last 18 months, but can last up to 36 months with an extension. Contact your local department of social services to inquire about Medicaid premium assistance programs.

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