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Medicare Enrollment: What You Need to Know About Dual Eligibility

medicare-enrollment-dual-eligibility

Dual eligibility can significantly change your Medicare enrollment options. According to HealthworksCollective.com, there are more than 9.7 million dual eligible beneficiaries in the U.S., but a large majority don’t know they qualify for this extra healthcare coverage. Our goal is to make understanding it a little easier. Here’s what you need to know about dual eligibility.

Dual Eligibility = Eligible for Medicare & Medicaid

Medicare and Medicaid are both healthcare coverage programs run by the Centers for Medicare and Medicaid Services (CMS), a federal organization. Medicare is primarily for individuals age 65 and older, as well as anyone with disabilities, end-stage renal disease (ESRD), or ALS. Medicaid is governed individually by each state, so eligibility and benefits vary. Eligibility is determined by income per month. Some states have different names for Medicaid, such as TennCare (Tennessee) or Medi-Cal (California).

Individuals who are eligible for both Medicare and Medicaid are considered dual-eligible, and can get benefits from both programs. Medicaid can also cover some of the costs from Medicare, like premiums, deductibles, and copays. Assistance is available at different levels depending on full or partial Medicaid eligibility. It’s important to know your eligibility before completing Medicare enrollment.

Dual Eligibility and Medicare Advantage Plans

Original Medicare — Parts A and B — is administered directly by the federal government through the Centers for Medicare and Medicaid Services (CMS). But CMS also approves certain insurance providers to offer Medicare Advantage Plans. These plans include all the coverage of Medicare Parts A and B and usually offer additional benefits, such as vision, dental, hearing, fitness, wellness, long-term care services, and prescription drug coverage.

Medicare Advantage Plans designed for people with dual eligibility are sometimes also called Special Needs Plans. These plans tailor their benefits, provider choices, and drug formularies to meet the specific needs of the groups they serve.

Dual Eligibility and Extra Help

If you’re dual eligible, you’ll most likely also qualify for Medicare Extra Help, which assists with the cost of prescription drugs. You can learn more about Extra Help here.

Get Help with Medicare Enrollment

To find out more about your dual eligibility status and Medicare Advantage Plans that can help you make the most of your benefits, call our Medicare Advocates at 1-800-991-4407 / TTY 711 from 10 a.m. to 9 p.m. Eastern, Monday through Friday. They can assist you with finding available plans in your area, comparing costs and benefits for plans from multiple carriers, and enrolling in the plan of your choice.

More Medicare Resources

Medicare Extra Help & Special Enrollment Periods
Why You Should Consider a Medicare Advantage Plan
Medicare Special Enrollment Before 65
Medicare Enrollment if You Have a Disability