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Author Archives: Frank Capollo

How Do You Become Dual Eligible for Medicare and Medicaid?

There are numerous health care benefits that are provided through the Medicare and the Medicaid programs. In some cases, there are individuals who could qualify for coverage through both.

When a person is eligible to obtain benefits through both Medicare and Medicaid, they are considered to be “dual eligible.” In most cases, these individuals have low incomes, are age 65 and over, and / or are disabled. Because Medicaid financial qualification varies by state, the amount of income and assets that are needed to qualify for your state’s poverty level will vary based upon where you reside.

The majority of those who qualify as being dual eligible can obtain full benefits through the Medicaid program. They may also receive assistance with paying their premiums for Medicare benefits. In these instances, Medicare will typically cover the cost of these individuals’ acute health care services, with Medicaid filling in any of the gaps in their Medicare benefits.

Today, it is estimated that there are roughly 9 million individuals who qualify as being dually eligible for the benefits of both Medicare and Medicaid based on the necessary criteria for benefits. Of these benefit recipients, approximately one-third are disabled, while the other two-thirds are low income elderly enrollees.

Dual Eligibles’ Benefits

Oftentimes, those who are considered as dual eligible will be able to qualify for benefits as a Qualified Medicare Beneficiary, or a QMB. What this means is that these individuals’ premiums for Medicare Part A and Part B, as well as their deductibles, coinsurance, and copayments for Medicare will all be covered by Medicaid. With this benefit, the individual will essentially be provided with full health care coverage.

Those who are dual eligible are also able to receive prescription drug benefits via a Medicare Part D prescription drug plan. Because of this, any person who is now a dual eligible and who was previously enrolled in a Medicare Advantage plan may be required to dis-enroll in their current health care plan in order to enroll in the Medicare Part D prescription drug plan.

Some plans may also offer additional benefits, as well, such as routine dental and vision coverage, dental care products, care coordination, and transportation benefits that help enrollees in getting to and from their health care appointments.

Medicare Special Needs Plans and Dual Eligibility

Medicare enrollees who are eligible for Special Needs Plans (SNPs) may also be able to qualify as dual eligibles. A Medicare Special Needs Plan is a type of Medicare Advantage (Medicare Part C) plan for Medicare enrollees who either suffer from certain types of chronic health conditions or who reside in certain types of institutions such as skilled nursing home facilities.

There are many Medicaid managed care plans that also offer Special Needs Plans to individuals who qualify for dual eligibility, allowing those who have lower incomes and / or are chronically ill to receive proper care.

It is required that Special Needs Plans provide care that is unique to the needs of the participants who are enrolled in the plans. Because of their expertise in serving these particular individuals, many of the Medicaid managed care plans also do the same.

How Do Medicare Private Fee For Service Plans Work?

When choosing between Original Medicare (Medicare Parts A and B) and Medicare Advantage, enrollees have many decisions to make regarding their benefits. However, those who decide to go with Medicare Advantage will still need to make additional choices in terms of how their benefits are structured. Medicare Advantage plans typically offer care to enrollees viaContinue Reading

Have You Been a Victim of Medicare Fraud?

Just like with other types of insurance related entities, fraud can – and does – exist with Medicare, and unfortunately, it can come in a wide variety of forms. Medicare fraud is considered to be either an “intentional deception or a misrepresentation that an individual knows to be false, yet makes anyway, knowing that theContinue Reading

Does Medicare Advantage Cover Medicare Part D?

Medicare Advantage plans offer health care coverage through traditional private insurance companies that are approved by Medicare. Because of this, Medicare is responsible for determining the rules on Medicare Advantage plans. Medicare is also responsible for regulating the Medicare Advantage plans themselves. These types of plans work in coordinating the benefits that are received viaContinue Reading

Want to Quit Smoking? Medicare Can Help

Medicare provides a wide array of health care services for its enrollees. These include hospitalization through Part A, doctors’ services through Part B, and prescription drug coverage via Part D. Yet, while most people think of Medicare as offering the basics of medical needs, what many may not realize is that the programs also offersContinue Reading

How Do You Switch from Medicare Advantage to Original Medicare?

For many enrollees who are in Original Medicare (Medicare Part A and Part B) or in Medicare Advantage (Medicare Part C), there may come a time when you feel that the current coverage you are receiving just isn’t right for your particular health care situation or needs. If this is the case, it may beContinue Reading

Medicare’s Extra Help Program and the Affordable Care Act

Anyone who has Medicare is allowed to also obtain Medicare’s prescription drug coverage. But for those who have a limited amount of income or other financial resources, it may be possible to qualify for help with health care and prescription drug costs through Medicare’s Extra Help program. Extra Help is a program through Medicare thatContinue Reading

When Putting Preventive Care Into Practice, How Much Does Medicare Cover?

Although Medicare covers a long list of health care services, the program also leaves a fair amount of gaps – and unfortunately, many of these come in the area of preventive care. There are, however, some services that the Medicare program will cover. Therefore, it is important to have a good understanding of which partContinue Reading