What is Medicare and Medicaid Dual Eligibility?

What is Medicare and Medicaid dual eligibility and can an individual qualify for both?

Medicare and Medicaid are not interchangeable programs.

Medicare is a federal program available to anyone age 65 and older. It has premiums and deductibles, so it is not a free program.

Medicare Consists of Four Parts

1. Part A- covers hospital care/admission and short-term nursing home for rehabilitation
2. Part B- covers doctor visits, medical equipment and preventative services
3. Part C- is a Medicare Advantage Plan (HMO/PPO)
4. Part D- covers prescription medication

Medicaid is a joint federal and state program that provides health care insurance to low-income families and people with disabilities. It is also the primary source of payment for long-term care services rendered at home or in a nursing facility.

It is possible to qualify for Medicare and Medicaid dual eligibility by enrolling in Medicare and full Medicaid or one of Medicaid’s Medicare Savings Programs for low-income beneficiaries.

Medicaid’s Medicare Savings Programs

• Full Medicaid– Recipients receive full Medicaid coverage including payment of Medicare Part B premiums.
• Qualified Medicare Beneficiary (QMB) Program– Recipients receive help paying Part A premiums (if they do not have enough work history to qualify for free Part A), Part B premiums, deductible, and coinsurance. Medicaid eligible persons who qualify for QMB cannot be charged Medicare co-pays.
• Specified Low-Income Medicare Beneficiary (SLMB) Program: Recipients receive assistance with Part B premiums.
• Qualified Individual Program (QI)– Pays Medicare Part B premium.

If you need help navigating the often complex Medicare and Medicaid programs available to you or a loved one, reach out to one of our experienced estate planning and elder law attorneys today.  We can help you fully understand the benefits available to you and assist you in securing the coverage you need.