medicare with medicaid Archives

Medicare Dual Plans

By Ed Crowe | General Articles | 0 comment | 22 June, 2023 | 0

Medicare Dual Plans

Medicare dual plans are also called dual eligible special needs plans. A Dual Eligible Special Needs Plan are know as a D-SNP. Plans are Medicare insurance plans that enrolls beneficiaries who are entitled to both original Medicare on a federal level and their state’s Medicaid plan. Depending on the state, many individuals on these plans will receive assistance with out-of-pocket costs, among other things. D-SNP plans are Medicare Advantage plans.

There are limited eligibility categories for this plan. To be eligible for dual enrollment, individuals must meet at least two categories simultaneously, one from Medicare eligibility and one from Medicaid eligibility.

To be qualified for original Medicare, an individual must be 65 years or older, a citizen of the United States of America, and live here the majority of the year. For some people who have chronic conditions such as end-stage renal failure, some cancers, or ALS, Medicare eligibility can come earlier because of their condition.

Medicaid requirements for enrollment are more complex, however, because they are state-dependent and can differ greatly by where an individual lives in the country. Generally speaking, those who are eligible for Medicaid must fall under a certain income threshold to be eligible for these benefits. There are some exceptions in Connecticut. For example, there are some disabilities that automatically qualify people for Medicaid benefits, known as Husky in Connecticut. The majority of the time, people who are 65 years or older and make under a certain percentage of their state’s income thresholds are considered dual eligible, or qualified to enroll for a D-SNP.

How Do You Know If You Qualify for One of the Medicare Dual Plans?

Despite the differences in state qualifiers, individuals who answer yes to the following questions are typically qualified for a D-SNP.

Do you qualify for Medicaid or get financial assistance from your state?
Enrolled in Medicare parts A and B?
Do you live in the coverage area of the dual enrollment plan’s insurance carrier?

Potential beneficiaries able to answer yes to these three questions are likely eligible for a Dual Enrollment Special Needs Plan.

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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.