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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.

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