How to Qualify for Medicaid and Medicare Dual Eligible

If you are one of the thousands of Americans turning 65 soon, you probably understand the need to sign up for Medicare. However, you might be less familiar with Medicaid and what the term “Dual Eligible” means. There are some very important things you should know about Medicaid and Medicare dual eligible plans.

What Is the Difference Between Medicaid and Medicare?

To be eligible for Medicare, the requirements are the same nationwide and are set by the federal government. The eligibility requirements are as follows:

You must be 65 years or older
Or, have a qualifying disability
You must be a U.S. citizen or permanent legal resident

Medicaid, on the other hand, varies from state to state. The federal government sets basic requirements for the program. Each state then determines additional eligibility standards. The purpose of Medicaid is to offer healthcare to people with low or no income.

What Is Medicaid and Medicare Dual Eligible?

The phrase “Dual Eligible” simply means you have dual coverage, Medicaid and Medicare Parts A and B. If you have Medicare and Medicaid, you may be able to enroll in a special health plan that offers extra benefits. Each state may have different rules to qualify.

Keep in mind that there are other names for the programs that combine Medicaid and Medicare dual eligible. It is also referred to as Dual Eligible Special Needs Plan (DSNP). You can have both Medicare Part A and Part B and Medicaid at the same time. Your Medicaid level will determine your qualification for this plan.

How Do I Qualify for Medicaid and Medicare Dual Eligible?

If you meet the criteria for Medicare, then you must see if you meet the requirements for Medicaid. Typically, Medicaid benefits are determined by your income. In most cases, there are four levels of Medicaid:

Qualified Medicare Beneficiary (QMB) Program
Specified Low-Income Medicare Beneficiary (SLMB) Program
Qualifying Individual (QI) Program
Qualified Disabled Working Individual (QDWI) Program

How Do I Enroll in Medicaid and Medicare Dual Eligible Plan?

If you are already a Medicaid beneficiary, to enroll in Medicaid and Medicare Dual Eligible plan, you must first contact your state Medicaid office. They will determine which level of Medicaid you currently have. Once you find this information out, contact MedicareInc.com and speak with a licensed Medicare insurance agent. You will be guided through which local insurance carriers offer this coverage and how to get signed up.

What Are the Benefits of the Medicaid and Medicare Dual Eligible Plan?

By combining Medicaid and Medicare plans, you can expect to receive additional benefits that are not offered through a stand-alone Medicare plan. Some of the additional benefits of Medicaid and Medicare Dual Eligible include prepaid debit cards for over-the-counter medications, additional coverage for hearing exams and hearing aids, vision coverage, dental plans, and transportation to health care visits. The benefits lists are typically offered to you at no additional cost.

Additional Tips

There are a few more things to consider with a Medicaid and Medicare Dual Eligible plan. These include:

Your current doctor or specialist might not accept this insurance plan or they might be out of network. You might have to choose another doctor or specialist if you have a Medicaid and Medicare Dual Eligible plan.
You can enroll in a Medicaid and Medicare Dual Eligible plan at any time of the year. As long as you have Medicare Part A, Part B, and Medicaid, there is no enrollment window to sign up.
Additionally, you are allowed to switch plans at any time and as often as you like.
If you do switch plans, you will have different coverage. This could mean that your doctor or specialist is now out of your network.

Final Thoughts on Medicaid and Medicare Dual Eligible

While the two names do sound alike, there is a difference between Medicaid and Medicare. There is also the possibility you can qualify for and receive benefits from Medicaid and Medicare Dual Eligible. You will, of course, need to be qualified through both programs.

If you have further questions regarding your eligibility, contact MedicareInc.com or call 480-382-1823.