Medicare + Medicaid
Have Medicare and Medicaid? You may qualify for more.
If you qualify for both programs, you’re “dual eligible.” Special plans called D-SNPs are built around both, and Medicaid may pay many of the costs Medicare leaves to you.
- Plans built for Medicare + Medicaid
- Often $0 plan premiums
- More chances to change plans
The basics
What “dual eligible” means
You’re dual eligible when you have Medicare, because you’re 65 or older or have a qualifying disability, and you also qualify for Medicaid based on income and resources.
Some people get full Medicaid benefits. Others qualify for a Medicare Savings Program, which helps pay Medicare premiums and, in some cases, deductibles and coinsurance.
Medicaid rules and income limits are set by each state, so what you qualify for depends on where you live.
D-SNPs
What a Dual Special Needs Plan can include
$0 or low premiums
Many D-SNPs have no monthly plan premium for members with full Medicaid and Extra Help.
Drug coverage
Part D coverage is built in, with Extra Help lowering your copays.
Dental, vision and hearing
Many plans include routine dental care, eyeglasses and hearing aids.
Over-the-counter allowance
Some plans include a credit for health products, and some help with groceries or utilities for members who qualify.
Care coordination
A care coordinator can help line up your Medicare and Medicaid benefits, appointments and services.
Transportation
Some plans include rides to medical appointments.
Benefits vary by plan, area and Medicaid level. Examples, not recommendations.
Help paying costs
Programs that can lower what you pay
Medicare Savings Programs
State programs (QMB, SLMB and QI) that can pay your Part B premium and, with QMB, Medicare deductibles and coinsurance.
Extra Help
Lowers Part D premiums, deductibles and drug copays. People with Medicaid or a Medicare Savings Program qualify automatically.
Medicaid
Can cover services Medicare doesn’t, such as long-term care and, in many states, home care, depending on your eligibility.
More chances to change plans
If you have Medicaid or Extra Help, you may be able to change certain Medicare coverage more than once a year, not only during Annual Enrollment. Ask us what applies to you before you switch.
Our process
How we help dual-eligible clients
- 1.Confirm your Medicaid and Medicare Savings Program status
- 2.Compare the D-SNPs offered in your area
- 3.Check that your doctors take both the plan and Medicaid
- 4.Price your prescriptions with Extra Help applied
- 5.Explain how the plan works with your Medicaid benefits
FAQ
Common questions
How do I know if I’m dual eligible?
If you have Medicare and a Medicaid card, or your state pays your Part B premium, you may be dual eligible. We can help you review your letters and check which plans you qualify for.
Will I lose my Medicaid if I join a D-SNP?
No. A D-SNP works alongside your Medicaid. You keep Medicaid as long as you continue to qualify under your state’s rules.
Do I have to pay for a D-SNP?
Many D-SNPs have a $0 monthly premium for members with full Medicaid. Your costs depend on your Medicaid level and the plan.
Can I keep my doctors?
D-SNPs usually use a network. Before you enroll, we check whether your doctors are in the plan’s network and accept Medicaid.
What if I have Extra Help but not Medicaid?
Extra Help alone doesn’t qualify you for a D-SNP, but it lowers your Part D costs and may let you change drug coverage more often. We can compare Part D and Advantage options for you.
Find out which dual plans you qualify for.
We’ll confirm your Medicaid level and compare D-SNPs in your area.