Qualifying for both Medicare and Medicaid gives you access to Medicare Advantage Dual Eligible Plans, designed to streamline your coverage and benefits. But how do they serve your healthcare needs?

This article will break down eligibility, coverage, and the additional services that could make these plans a smart choice for dual-eligible individuals.

Key Takeaways

• Medicare Advantage Dual Eligible Plans are for individuals who qualify for both Medicare and Medicaid, possibly providing an integrated suite of benefits that could include Medicare Part A, Part B, Part D, and additional services that might not be covered under Original Medicare.

• There will likely be specific Dual Eligible Special Needs Plans (D-SNPs) available that could offer specialized care and additional benefits, such as $0 co-pays and deductibles, tailored coordination of care, and extra services like dental and vision for individuals who are fully eligible for Medicare and Medicaid.

• Eligibility for these plans requires meeting certain criteria for both Medicare and Medicaid, and enrollment can be done during specific periods such as the first nine months of the year using a Special Enrollment Period, or during the Medicare Annual Enrollment Period.

Understanding Medicare Advantage Dual Eligible Plans

Medicare Advantage Dual Eligible Plans will likely be designed for individuals who qualify for both Medicare and Medicaid, potentially offering comprehensive coverage and coordinated benefits.

These Medicare Advantage plans integrate Medicare Part A and Part B benefits, and sometimes Part D prescription drug coverage and other supplementary health benefits, possibly providing comprehensive coverage and additional services that could go beyond what Original Medicare offers.

The possible flexibility and additional benefits that could be provided by these plans might have led to an increase in their popularity, particularly among dual-eligible members under 65.

However, keep in mind that not all dual-eligible individuals choose a dual-eligible plan, and in numerous states, more than 50% of the dual-eligible population had received their Medicare coverage through traditional Medicare.

Defining Dual Eligibility

Being dual eligible will likely signify that an individual meets the criteria for both Original Medicare and full Medicaid benefits. Full dual-eligible individuals could receive complete Medicaid benefits from their state’s program, which might include coverage for Medicare Part A and B premiums as well as various out-of-pocket costs.

On the other hand, partially dual-eligible individuals qualify for Medicaid but may not receive full medical benefits and could have some out-of-pocket costs depending on their income. The income thresholds for qualifying as dual eligible may vary depending on the program and state.

The Role of Medicare Advantage in Dual Eligibility

Medicare Advantage could potentially provide additional benefits and aid for dual-eligible individuals.

Dual Eligible Special Needs Plans (D-SNPs), a specialized category of Medicare Advantage plan, may be specifically designed to deliver some of these additional benefits to those who are dual-eligible and fall under specific eligibility categories.

A Dual Eligible Special Needs Plan (D-SNP) is a managed care plan that could be tailored to individuals who are eligible for both Medicare and state Medicaid assistance. This plan might be able to offer supplementary benefits and coordinate care to address their specific needs.

Some of the potential benefits of a D-SNP include:

• Coverage for both medical and prescription drug costs

• Access to a network of doctors and specialists

• Care coordination services to help manage multiple health conditions

• Additional benefits such as dental, vision, and transportation services

The federal government and state governments will likely work together to provide these benefits.

Unpacking the Coverage: What’s Included?

Dual Eligible Plans will likely encompass Medicare Part A, Part B, and Part D, providing coverage for inpatient hospital, medical insurance, and prescription drugs.

Additionally, some plans may also integrate benefits and services that could go beyond what Original Medicare offers, streamlining care and potentially enhancing health outcomes for dual eligibles.

How to Qualify for a Dual Eligible Plan

Individuals must meet the eligibility standards for both Medicare and Medicaid to qualify for a Dual Eligible Plan. This will likely involve meeting the requirements for a Medicare Advantage plan and being eligible for Medicaid benefits, including Medicaid coverage.

To be eligible for Medicare, an individual must meet specific requirements, including being aged 65 or older, a U.S. resident, and either a U.S. citizen or a legal permanent resident who has resided in the U.S. for at least 5 continuous years before applying.

Additionally, individuals under 65 may qualify if they have a disability or are diagnosed with End-Stage Renal Disease.

Enrollment Periods and Procedures

Eual-eligible individuals who satisfy Medicaid eligibility can enroll in a Dual Special Needs Plan during the first nine months of the year using a Special Enrollment Period.

Furthermore, if an individual loses eligibility while being enrolled in a D-SNP, they will be granted a Special Enrollment Period to discontinue their enrollment and select an alternative plan.

If they have Medicaid, individuals can enroll in a Dual Special Needs Plan whenever they wish. They are permitted to switch their plan once per quarter from January 1 through September 30.

Furthermore, plan switching is also available during the Medicare Annual Enrollment Period from October 15 through December 7.

To enroll, call one of our licensed agents at 1-833-641-4938 (TTY 711), Mon-Fri 8 am-9 pm EST. They can provide comprehensive information, personalized guidance, and ongoing assistance to navigate the enrollment process for private insurance companies, making it easier for beneficiaries to make informed decisions about their healthcare.