Dual-Eligible? Medicare + Medicaid Coverage Options
Understanding Dual Eligibility
Being “dual eligible” means you qualify for both Medicare (federal health insurance for people 65+ or with certain disabilities) and Medicaid (state and federally funded health coverage for those with limited income and assets). When you have both, Medicare usually pays first for your medical needs, while Medicaid helps with premiums, copays, deductibles, and sometimes extra benefits like long-term care or dental coverage. Dual-eligible status can make healthcare far more affordable and cover services that Medicare alone does not. The rules and benefits may differ by state, so understanding your local options is key. True North Associates is here to help you get clarity on what’s available.
Medicare Savings Programs for Dual-Eligibles
Several programs help people with limited income pay their Medicare costs. These include the Qualified Medicare Beneficiary (QMB) program, Specified Low-Income Medicare Beneficiary (SLMB), and others. These programs may cover your Medicare Part A and B premiums, deductibles, and cost-sharing. If you qualify, you could pay little or nothing for doctor visits, hospital care, or prescriptions. True North Associates helps you determine eligibility and complete the necessary steps for these valuable savings programs.
Dual Special Needs Plans (D-SNPs): Coordinated Medicare & Medicaid
Dual Special Needs Plans (D-SNPs) are a type of Medicare Advantage plan made specifically for people who have both Medicare and Medicaid. D-SNPs coordinate all your benefits so you get medical, prescription, and often additional services like vision, dental, transportation, and care management—usually at little or no cost. Medicaid may cover premiums and most out-of-pocket costs, and the plan takes care of organizing your benefits to reduce paperwork and confusion. D-SNPs can be a great way to streamline your care, but you’ll want to check that your doctors and prescriptions are included in the plan’s network. We guide you through comparing D-SNPs and making the right selection for your needs.
How We Help Dual-Eligible Clients
Navigating dual eligibility can feel complicated, but True North Associates makes it easier every step of the way. We help you determine if you qualify for both Medicare and Medicaid, and explain your options for specialized plans like D-SNPs. Our team verifies your providers, medications, and benefits, then assists with enrollment to make sure there are no gaps in your coverage. If your status changes—such as gaining or losing Medicaid—we explain your next steps and help you switch to an appropriate plan. Our goal is to ensure you always have the best possible coverage, support, and peace of mind.
Frequently Asked Questions About Dual Medicare-Medicaid Coverage
If I have Medicaid, do I pay anything for Medicare Advantage?
In most cases, if you enroll in a Dual Special Needs Plan (D-SNP), Medicaid will cover your Medicare Advantage premiums and most out-of-pocket costs. You may still be responsible for small copays depending on your state and the specific plan. Many people pay little or nothing for their healthcare when both programs are in place. We’ll review your options to confirm what’s covered for you.
Can I keep my doctors on a dual plan?
Whether you can keep your current doctors depends on the D-SNP’s provider network. Some plans have broad networks, while others are more limited. We always check your preferred doctors and specialists to make sure they participate before you enroll. This way, your care remains consistent and uninterrupted.
What happens if my income changes and I lose Medicaid?
If you lose Medicaid eligibility, you will typically qualify for a Special Enrollment Period to switch to a different Medicare plan. You might need to pay higher premiums or copays once Medicaid support ends, but you will not lose all coverage. It’s important to report any income changes right away and review your options quickly. True North Associates will help you understand your choices and keep your coverage in place.
Do I need Medicare Part D if I have Medicaid?
Yes, prescription drug coverage is still important, but most D-SNPs include a Medicare Part D plan automatically. Medicaid may also help with any remaining drug costs or “extra help” programs. You should always review the plan’s drug formulary to make sure your medications are covered. We’ll assist in comparing options to ensure you have complete prescription coverage.
What insurance can I get if I have both Medicare and Medicaid?
Dual-eligibles can enroll in D-SNPs, stay with Original Medicare plus Medicaid, or sometimes choose other Medicare Advantage plans. D-SNPs often provide the most coordinated and comprehensive coverage, but the right choice depends on your health, providers, and state rules. We’ll help you evaluate every option to make sure you have the right mix of benefits and support.
Get the Most From Your Dual Eligibility
If you qualify for both Medicare and Medicaid, you have access to some of the best health coverage options available. Understanding how these programs work together and what plans are right for you can make a real difference in your care and costs. True North Associates helps you navigate every detail so you can maximize your benefits and avoid coverage gaps. Take control of your healthcare with expert, compassionate guidance on your side.
Ready for Dual Coverage Guidance?
If you or a loved one are dual-eligible or think you might qualify, reach out to True North Associates today. We’ll answer your questions, verify eligibility, compare D-SNP plans, and guide you through enrollment—all at no cost. Make sure you’re getting all the coverage and support you deserve.
