What it means to be dual eligible for Medicare and Medicaid

Many seniors on Medicaid who are approaching Medicare eligibility ask an important question – will I lose my Medicaid if I get Medicare?

The answer is not necessarily. You can have both at the same time, because while Medicare and Medicaid are separate programs, they can work together.

Let’s talk about what it means to be dual eligible, how seniors qualify, and plan options that can help you get the care and coverage you need.

When you’re dual eligible, you qualify for both Medicare and Medicaid. This means you can keep your Medicaid after you turn 65. To do so, you must meet eligibility standards for both programs. Each has its own qualification criteria such as age, income, household size, disability status and more.

When you’re covered by both programs, your Medicare plan covers Medicare-approved health care costs. Then Medicaid covers the rest. Also, if necessary, Medicaid may help pay for cost-sharing amounts and services Medicare may not cover.

If you’re eligible for both Medicare and Medicaid, you can still choose how to receive your Medicare coverage. This means you can stick with Original Medicare, or you can choose a Medicare Advantage plan. In fact, there are special Medicare Advantage plans for those who are dual eligible called Dual Eligible Special Needs Plans (D-SNPs) that combine both programs and their coverage benefits.

Better together: Key benefits of a Dual Eligible Special Needs Plan (D-SNP)

A D-SNP combines Medicare and Medicaid to help low-income beneficiaries who are 65 or older access affordable care. In Minnesota, the plan name for dual eligible enrollees is Minnesota Senior Health Options (MSHO).

An MSHO plan is a type of Medicare Advantage plan that offers elements of both Medical Assistance (Medicaid) and Medicare, combining medical, hospital, prescription drug coverage and more.

Getting your Medicare and Medical Assistance services in one plan is convenient and affordable, and it helps you get the coverage you need. For instance, Original Medicare doesn’t cover the cost of long-term and personal care facilities, but Medical Assistance may cover it. Also, most D-SNPs don’t have a monthly premium and include Medicare Part D prescription drug coverage and may include some dental services.

Not all D-SNPs are the same. For example, some have supplemental benefits to help you stay healthy, like fitness programs, meal delivery and more. When you’re looking for a dual plan, always make sure to check the full list of benefits. This way you can choose the best plan for you.

How a D-SNP works

It’s important to understand how D-SNPs work in practice. With many MSHO plans, you’ll choose a primary doctor to manage your care. Your primary doctor can refer you to a specialist or get health plan approval for specific types of care.

This type of plan will have a network of doctors, clinics and hospitals. Check the plan’s provider directory to make sure you’re receiving care in network. You will have to pay for services you get out of the network (except for emergencies, out-of-area urgently needed care or renal dialysis). For home and community-based services, MSHO plans use every provider that is enrolled with the state.

You’ll also have a Care Coordinator to guide your health care. This person is usually a registered nurse or a licensed social worker. You can expect your Care Coordinator to:

• Explain how your plan works
• Partner with you to understand your key health goals and create a person-centered care plan, then provide you with support and tools to reach those goals
• Help navigate Medicare and Medical Assistance services you may be eligible for, like home health care, personal care assistance, homemaker and companion services, delivered meals or home safety equipment

Dual eligibility: You can have Medicare Part D prescription drug coverage and Medicaid

If you have Medicare and Medicaid, you will automatically be eligible for Medicare’s Extra Help program, and Medicare will automatically enroll you in a Part D plan. Part D will cover your outpatient prescription drugs, and Medicaid may even cover drugs Medicare won’t.

For those with a dual eligible special needs plan, Medicare Advantage typically includes Part D prescription drug coverage.

Who is eligible for a dual Medicare and Medicaid plan?

To be eligible for a D-SNP, you must qualify for both Medicare and Medicaid individually. To get started, confirm you qualify for both programs separately based on Medicare and Medicaid eligibility requirements.

With Medicare, you become eligible three months before you turn 65 or if you have a disability, amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD). You can get an eligibility estimate or talk with a Medicare support team member through the official Medicare website.

Eligibility for Medicaid depends on which state you live in and your current financial situation. For more information about seniors’ eligibility for Medical Assistance in Minnesota, head to the Minnesota Department of Human Services website.

There are income limits for Medicaid

To be dual eligible, you must qualify for Medicaid. Medicaid qualification requirements vary by state and are based on income levels. In Minnesota, Medical Assistance eligibility requirements include income limits, citizen status and more.

Can you be eligible for a Medicare supplement plan and Medicaid?

No, if you have full Medicaid coverage alongside Medicare, insurance companies are not legally allowed to sell you a Medicare supplement plan, also known as Medigap. But don’t worry – you likely wouldn’t need a Medicare supplement insurance plan if you’re dual eligible, because Medicaid will cover many of the costs that Medicare doesn’t.

How to enroll in an MSHO plan

If you’re a resident of Minnesota and think you’re eligible for an MSHO plan, you can get the information you need about how to apply from the following sources: