Dual Eligible Medicare and Medicaid is a program that provides healthcare coverage to individuals who are eligible for both Medicare and Medicaid. This program is designed to help people with low income and limited resources get the healthcare they need.
If you’re one of the 12 million people in the United States who are eligible for both Medicare and Medicaid, you may have questions about how the program works and what benefits you’re entitled to. In this article, we’ll answer some of the most common questions about Dual Eligible Medicare and Medicaid and provide you with the information you need to make informed healthcare decisions.
What is Dual Eligible Medicare and Medicaid?
Dual Eligibility is a program that provides healthcare coverage to individuals who are eligible for both Medicare and Medicaid. Medicare is a federal health insurance program for people who are 65 or older, people with certain disabilities, and people with end-stage renal disease. Medicaid is a joint federal and state program that provides healthcare coverage to people with low income and limited resources.
Dual Eligible beneficiaries are individuals who are eligible for both Medicare and Medicaid. The Dual Eligible program combines the benefits of both programs to provide comprehensive healthcare coverage to eligible individuals.
Watch the explainer video here >>>
How does Dual Eligible Medicare and Medicaid work?
Dual Eligible beneficiaries receive healthcare coverage through the Dual Eligible Medicare and Medicaid program. The program combines the benefits of both Medicare and Medicaid to provide comprehensive healthcare coverage.
Under the program, beneficiaries may receive the following benefits:
- Medicare Part A (hospital insurance)
- Medicare Part B (medical insurance)
- Medicare Part D (prescription drug coverage)
- Medicaid benefits, including long-term care services, home and community-based services, and nursing home care
The specific benefits you’re entitled to will depend on your individual circumstances and the state you live in. Your healthcare provider or state Medicaid agency can provide you with more information about the benefits available to you.
What are the benefits of Dual Eligible Medicare and Medicaid?
There are many benefits to being a Dual Eligible beneficiary. Some of the key benefits include:
- Comprehensive healthcare coverage: Dual Eligible beneficiaries receive comprehensive healthcare coverage that combines the benefits of both Medicare and Medicaid. This coverage can include hospitalization, doctor visits, prescription drugs, and long-term care services.
- Lower out-of-pocket costs: Dual Eligible beneficiaries may have lower out-of-pocket costs for healthcare services. Medicaid can help cover the costs of services that Medicare does not cover, such as dental and vision care.
- Access to more healthcare providers: Dual Eligible beneficiaries have access to a wider network of healthcare providers. Medicaid providers may be more likely to accept Dual Eligible beneficiaries than Medicare providers, which can make it easier to find a healthcare provider who accepts your insurance.
How do I know if I’m eligible for Dual Eligible Medicare and Medicaid?
In order to be eligible for full Medicaid benefits, Medicare beneficiaries must meet their state’s specific Medicaid eligibility criteria. While states are mandated to provide coverage to Medicare beneficiaries who receive Supplemental Security Income, they may also opt to cover additional groups such as individuals with an income below the federal poverty level and those who require long-term services and supports.
It’s important to note that not all full-benefit Medicare-Medicaid enrollees are eligible for Medicare premium and cost-sharing assistance through the Medicare Savings Programs, which are administered by individual states. The federal government has established minimum income and resource limits for each of the Medicare Savings Programs, which are updated annually by the Centers for Medicare and Medicaid Services (CMS).
Each program has varying eligibility criteria and coverage, depending on the assistance needed and state of residence.
Are there any costs associated with Dual Eligible Medicare and Medicaid?
Dual Eligible beneficiaries may be responsible for certain costs associated with their healthcare coverage. These costs can include copayments, coinsurance, and deductibles for Medicare-covered services.
However, Medicaid can help cover the costs of services that Medicare does not cover, such as dental and vision care. This can help reduce your out-of-pocket costs and make healthcare more affordable.
Conclusion
If you’re eligible for both Medicare and Medicaid, Dual Eligible can provide you with comprehensive healthcare coverage that meets your needs. This program can help you save money on healthcare costs and ensure that you receive the care you need.
To find out if you’re eligible for Dual Eligible, contact your state Medicaid agency or healthcare provider. They can provide you with information about the program and help you enroll if you’re eligible.
With Dual Eligible, you can rest assured that you’re getting the healthcare coverage you need to stay healthy and live your best life.
Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.
*By completing this form, you agree that an authorized representative or licensed insurance agent may contact you by phone,email,text, mail or face to face to answer your questions or provide additional information about your Medicare plan options. Not affiliated or endorsed by Medicare or any state or federal governmental agency.
