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Medicare and Medicaid Dual Eligible

By Ed Crowe | General Articles | 0 comment | 18 May, 2023 | 0

Medicare and Medicaid Dual Eligible

Although Medicare and Medicaid sound very much alike, they are different programs. Their similarities are that both help people secure healthcare and both are federally funded. Some people are qualified to receive benefits from both Medicare and Medicaid and can choose to do so. This group of beneficiaries is considered to have dual eligibility – Medicare and Medicaid dual eligible.

Medicare vs Medicaid

Briefly, here are some of the major differences between the two programs.

Medicare is a federally funded health program that provides insurance for people who are 65 and older at a reduced cost. Some people who are under 65 but have certain disabilities may qualify as well. Medicare is offered by the federal government. The cost of Medicare will depend on the coverage the beneficiary chooses and may include premiums, down payments, copays, and co-insurance.

Medicaid is a joint federal and state funded health insurance program. It seeks to provide health care and resources to vulnerable populations such as those on limited income, pregnant people, and children. Medicaid is offered by state governments and therefore the cost to the beneficiaries will vary by location.

How to Get Medicare and Medicaid

In order to receive benefits from both Medicare and Medicaid, a beneficiary must qualify for both of these programs. For instance, someone who is over 65 years old and is also on a lower or limited income may qualify to receive both Medicare and Medicaid. The two programs may be able to work together to cover the majority of health costs. Some specific plans exist for those people that are dual eligible as well, such as the Dual Special Needs Plan (D-SNP). Because Medicaid requirements are dependent on location and state governments, however, Medicaid eligibility will vary.

There are beneficiaries that are considered part duals and full duals. Part duals are called this because Medicaid pays for some of the expenses that they accumulate under their Medicare plan. It may also pay for some cost-sharing amounts categorized by Medicare, like deductibles or copayments. Part duals can include people who are disabled and working, or have an income level above the state poverty line but below 125% of federal poverty level.

Full duals, on the other hand, are entitled to Medicaid coverage for services that Medicare does not cover, such as longer-term services and supports. Duals with lower income and assets will fall under full Medicaid benefits as well as their Medicare eligibility. Because this group of people can account for much of the federal and state spending in these programs, they are studied by researchers and policymakers to determine budgets and planning.