Medicare beneficiaries who are also eligible for Medicaid are considered dual eligible. If you are Medicare dual eligible, you may qualify for a Medicare D-SNP (Dual Special Needs Plan), which is a type of Medicare Advantage plan. D-SNP plans are not available in all states.
More than 12 million Americans are dually eligible for Medicare and Medicaid and are enrolled in both programs.1
Beneficiaries who are eligible for this combination of coverage are sometimes called Medicare-Medicaid dual eligible.
If you are dual eligible for Medicare and Medicaid, you may qualify for a special type of Medicare Advantage (Part C) plan called a Medicare Dual-Eligible Special Needs Plan (D-SNP). These plans aren’t available in all locations, however, so be sure to compare local plan options where you live.
We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.
Medicare is for people age 65 and over and for certain people under 65 who have a qualifying disability. Medicare eligibility is consistent for everyone across the U.S., no matter what state you live in.
Medicaid is for people of any age who meet certain income qualifications. Medicaid is administered by state governments, and eligibility requirements can differ between states.
Who is dual eligible for Medicare and Medicaid?
To be Medicare dual eligible, you have to meet the requirements for Medicare and your state’s Medicaid program.
To be eligible for Medicare, you must:
Be at least 65 years old or having a qualifying disability or health condition
Be a U.S. citizen or permanent legal resident
Be eligible for benefits through Social Security or the Railroad Retirement Board
Generally speaking, Medicaid provides health insurance to individuals and families, children and pregnant women who are eligible based on income specific income thresholds.
If you're eligible for Medicaid and want to find out if you're also eligible for a dual-eligible Medicare Medicaid plan, you can all to speak with a licensed insurance to find out if you're eligible and if any dual-eligible Medicare-Medicaid plans are available where you live.
What type of coverage do you get if you are dual eligible for Medicare and Medicaid?
There are two levels of coverage for beneficiaries who are dual eligible:
Full dual eligible Full dual eligible refers to those who receive full Medicaid benefits and are also enrolled in Medicare.
People who are full dual eligible typically receive Supplemental Security Income (SSI) benefits, which provide cash assistance for basic food and housing needs.
Qualifying as full dual eligible is based on your assets, which include checking and savings accounts, stocks, real estate (other than your primary residence) and vehicles (if you own more than one).
Partial dual eligible Partial dual eligibility includes those who receive assistance from Medicaid in order to help pay for Medicare costs such as premiums, coinsurance or deductibles.
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
If your Medicare card is lost, stolen or damaged, you can get a replacement card from Social Security and the Railroad Retirement Board, or by calling Medicare or logging into your My Social Security online account. Read more