Dual Eligibility Explained: Medicare and Medicaid Benefits
Worried about rising medical bills? If you’re a senior, understanding Medicare and Medicaid dual eligibility could be the key to protecting your health and finances.
Someone who can get both Medicare and Medicaid is considered dual eligible. Medicare and Medicaid dual eligibility is usually determined by one’s income and age, alongside any disabilities. Many seniors miss out on extra benefits as they might not know they qualify for Medicare and Medicaid dual eligibility.
It helps save seniors thousands over time since it majorly cuts down on healthcare costs and protects finances.
What is Dual Eligibility?
What is Medicare?
What is Medicare?
Now we’ll talk more about Medicare and Medicaid dual eligibility and what benefits it has, such as Medicaid long-term care benefits.
But First, What Is Medicare?
Medicare is a federal health insurance program in the United States for people over 65. Don’t be worried if you or someone you know is under 65 with certain disabilities or kidney problems. They too are eligible for it. Learning how to apply for Medicare is crucial for accessing these benefits.
Since it is a federal program, Medicare ensures that the coverage depending on the state does not vary. This means that whether the person lives in Alaska or Florida, Medicare benefits for seniors remain consistent. What does it cover?
Part A: Hospital Insurance (premium-free)
- Administered by the government.
- Covers hospital stays, killed nursing facilities, and some home health care.
- It costs $0 for most people since they (or their spouse) contributed through payroll taxes during their working years.
- If you’re not qualified for premium-free Plan A, you can still buy it. The cost per month would depend on how long you or your spouse worked and paid Medicare taxes.
Part C: Medicare Advantage Plan
- Administered by private insurance companies
- A combination of the benefits in Part A and Part B, and usually includes some from Part D too.
Part B: Medical Insurance (monthly premium)
- Administered by the government.
- Helps pay for doctor visits or outpatient care. Includes preventive services as well.
- A monthly payment is required each month.
- If your workplace offers health insurance at age 65, you don’t have to sign up right away. But if you don’t have insurance through your job and later decide you want to sign up, you might have to pay a late-enrollment fee.
Part D: Prescription Drug Coverage (optional but important)
- Administered by private insurance companies
- Provides coverage for prescription medication, so that seniors can afford the medicine they need.
While many services are covered by Medicare, it isn’t exactly completely free. Few treatments such as dental or vision, or even long-term health care aren’t covered by Medicare. Nor are costs like copays, deductibles, and premiums. Understanding Medicare and Medicaid dual eligibility and Medicaid long-term care benefits can help fill these gaps.
Want a simple breakdown of which Medicare plan fits your needs? Get personalized guidance here.
What Is Medicaid?
Medicaid is a combined health care insurance program initiated by the US federal government and the states. Its purpose is to assist low-income Americans with limited financial resources in paying for medical treatment.
Medicaid is different from Medicare. Since it is based on financial need, no work history or age is needed. However, the rules and benefits also vary state by state, which is why determining Medicaid eligibility for seniors is key to accessing this support.
Medicaid often covers services that Medicare doesn’t, like:
- Long-term nursing home care
- Transportation costs
- Personal care services
This is why Medicare and Medicaid dual eligibility is an essential support system for seniors struggling with high healthcare expenses. Medicaid long-term care benefits can really add up the support.
How is Dual Eligibility Related To Medicaid and Medicaid?
A ‘dual eligible’ individual qualifies for both Medicare and Medicaid programs. This means that seniors get health coverage from both systems at the same time , maximizing Medicare benefits for seniors.
Medicare is always the primary payer since it ensures the person receives Medicare-covered services. Medicaid pays after, which means that any other costs you have after Medicare or other health insurances are covered by Medicaid, like the premium for Plan B in Medicare.
If you are enrolled in Medicare and Medicaid dual eligibility, it automatically means Medicare covers your prescription drugs.
Who Qualifies?
Just because someone qualifies for both Medicare and Medicaid means they will receive the same level of help as the rest. An individual’s income and assets place them into a different category based on the specific state rules.
So don’t skip out on checking Medicaid eligibility for seniors to understand your options.
There are two types of Medicare and Medicaid dual eligibility:
Full Dual Eligibility
To be considered fully dual eligible, the person must be enrolled in:
- Medicare: Medicare Part A and/or Medicare Part B (medical insurance) OR may opt for Medicare Part C.
- Medicaid: Full-benefit Medicaid.
Benefits Include:
- All Medicare-covered services
- Full Medicaid benefits, which may include long-term care and prescription drugs
- Help with premiums and copayments
This is the most comprehensive form of Medicare and Medicaid dual eligibility.
Partial Dual Eligibility
For partial dual eligibility, a person must be enrolled in Medicare through a Medicare Savings Program (MSP) only. This is because their income or assets exceed full Medicaid limits.
They will receive help with paying Medicare premiums for Part A and Part B, deductibles and copayments based on their MSP category.
Types of Dual Eligibility Programs
It is no secret that Medicare and Medicaid dual eligibility programs are often confusing or overlooked since. Why? Because being dual eligible means that there is a variety of programs available to you. These options help you access more services and cut down on bills, while reducing paperwork at the same time.
This is exactly why we should know about options that can be key to accessing more affordable healthcare. Medicaid eligibility for seniors and the state you live in determines what plans you qualify for.
Medicare Savings Programs (MSPs)
Depending on the income level, Medicare and Medicaid dual eligibility via Medicare Savings Programs (MSPs) usually aids with Medicare Part A and B costs. Made to help low-income seniors and people with disabilities, they help seniors save hundreds of dollars each month on Medicare expenses.
With Medicare and Medicaid dual eligibility, seniors are able to free up money for necessities such as housing or food, enhancing Medicare benefits for seniors.
Medicare Savings Programs come in different types. This is exactly why understanding these will help you choose the best program for your needs.
QMB – Qualified Medicare Beneficiary
Qualified Medicare Beneficiary (QMB) without any other Medicaid coverage cover Medicare Part A and Part B premiums.
This applies to people who have an income below 100% of the federal poverty level (FPL) and resources are under three times the limit for supplementary security income eligibility.
In QMB “full-benefit,” on the other hand, a person meets the standards for both QMB and another eligibility group. This means they can get all the benefits from both programs.
SLMB – Specified Low-Income Medicare Beneficiary
Only the Part B premium is covered under this program. Although you would still have to pay for deductibles and coinsurance, this plan is perfect for seniors whose income is just above the QMB level.
However, you are eligible for Medicare Part A coverage if you have no other Medicaid assistance (also known as SLMB “partial-benefit”). The additional conditions are that your income must be between 100% and 120% of the FPL and your resources are less than three times the SSI eligibility limit.
QI – Qualifying Individual
This program also covers Part B premiums. To help people with slightly better incomes than SLMB pay their Medicare Part B premiums, the federal government is offering funding for certain slots. Hence, it is recommended to apply early each year.
Curious which MSP you qualify for? Learn how to apply for Medicare at Senior Services Simplified
Start Your Dual Eligibility Application
The process is simple. All you need to do is:
- Check your Medicaid eligibility for seniors
- Gather the necessary documents
- Apply for Medicaid, by contacting your state’s Medicaid agency.
- Enroll in medicare if you aren’t already enrolled.
Take Charge of Your Healthcare Today
Don’t miss out on benefits that could save you thousands. Understanding Medicare and Medicaid dual eligibility might seem daunting at first, but it’s something which most seniors qualify without realizing.
We’re here to make it easy. Contact Us and let our experts handle your dual eligibility process
