How Do I Qualify for Dual Medicare and Medicaid?: Navigating Eligibility Criteria for Comprehensive Healthcare Coverage

How to Get the Best of Both Worlds: Dual Eligibility for Medicare and Medicaid

If you are a low-income senior or a person with a disability, you may be wondering how to get the most out of your health care coverage.

You may have heard of Medicare and Medicaid, but do you know the difference between them? And more importantly, do you know if you can qualify for both programs at the same time?

Medicare and Medicaid
Photo Courtesy: aarp.org

 

In this blog post, we will explain what Medicare and Medicaid are, how they work together, and how you can become a dual eligible beneficiary.

We will also share some tips on how to apply for dual eligibility and what benefits you can expect from it.

By the end of this post, you will have a better understanding of how to get the best of both worlds: dual eligibility for Medicare and Medicaid.

 

What is Medicare and Medicaid?
An image illustration of medicare and medicaid

 

What is Dual Eligibility?

Dual eligibility means that you qualify for both Medicare and Medicaid at the same time. There are about 12 million people in the US who are dual eligible beneficiaries.

Depending on your income and assets, you may be eligible for full or partial dual eligibility.

Full dual eligibility means that you are enrolled in Medicare and receive full Medicaid benefits.

This means that Medicaid will pay for most or all of your Medicare out-of-pocket costs, such as premiums, deductibles, coinsurance, and copayments.

Medicaid will also cover some services that Medicare does not cover, such as dental care, vision care, hearing aids, and personal care assistance.

Partial dual eligibility means that you are enrolled in Medicare and receive some assistance from Medicaid to pay for your Medicare costs.

There are four types of Medicare Savings Programs (MSPs) that provide different levels of assistance:

  • Qualified Medicare Beneficiary (QMB) Program: Pays for Part A and Part B premiums, deductibles, coinsurance, and copayments.
  • Specified Low-Income Medicare Beneficiary (SLMB) Program: Pays only Part B premium.
  • Qualifying Individual (QI) Program: Pays only Part B premium (individuals enrolled in this program have no other Medicaid eligibility).
  • Qualified Disabled Working Individual (QDWI) Program: Pays only Part A premium for certain individuals under age 65 with disabilities who have returned to work.

 

What are the Benefits of Dual Eligibility
An image illustration of the benefits of dual eligibility

 

How to Qualify for Dual Eligibility?

To qualify for dual eligibility, you must meet the eligibility criteria for both Medicare and Medicaid. For Medicare, you generally need to be 65 or older, or have a qualifying disability.

For Medicaid, you need to meet the income and asset limits set by your state.

These limits vary by state, but generally, they are based on the Federal Poverty Level (FPL) and the Supplemental Security Income (SSI) program.

The FPL is a measure of income that determines eligibility for various federal programs.

In 2020, the FPL for an individual was $12,760 per year, and for a couple, it was $17,240 per year.

The SSI program provides cash assistance to people who are aged, blind, or disabled to help them meet basic needs.

In 2020, the maximum income provided by the federal government for SSI was $783 per month for an individual and $1,175 per month for a couple.

To qualify for SSI, you must have assets limited to $2,000 for an individual (or a child) and $3,000 for a couple.

Qualifying assets typically include things like checking and savings accounts, stocks, real estate (other than your primary residence), and vehicles if you own more than one.

medicine
Photo Courtesy: investopedia.com

 

How to Apply for Dual Eligibility?

To apply for dual eligibility, you need to apply for both Medicare and Medicaid separately.

You can apply for Medicare online at Social Security website, by phone at 1-800-772-1213, or in person at your local Social Security office.

You can apply for Medicaid online at Healthcare.gov, by phone at 1-800-318-2596, or in person at your local Medicaid office.

Furthermore, you can also contact your state Medicaid agency to find out more about the application process and the documents you need to provide.

When you apply for Medicaid, you should indicate that you are also enrolled in Medicare or that you are applying for Medicare.

This way, the Medicaid agency can determine if you are eligible for full or partial dual eligibility and enroll you in the appropriate program.

You may also be automatically enrolled in a Medicare Savings Program if you are receiving SSI or if your income is below a certain level.

 

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