What is Dual Eligibility?

Dual Eligibility is when an individual qualifies for both Medicare and Medicaid. It’s often easy to confuse the two, but understanding the differences and how the programs work together can help you make the most out of your healthcare experience.

Both programs provide a variety of benefits. Medicare is a federal health insurance program for seniors and disabled persons and Medicaid is a state and federal medical assistance program for people with limited incomes and resources.

We can help make sure you’re getting the most out of your coverage and receiving the benefits you deserve. There’s no obligation to enroll.

How to Qualify for Both Medicare and Medicaid

Medicare Eligibility

Medicare Eligibility is the same across all states. Individuals must be U.S. citizens or legal residents residing in the U.S. for a minimum of 5 years. Additionally, applicants must also meet one of the following:

Be at least 65 years old
Have a disability (individual has been declared “legally disabled” for 24 months)
Have been diagnosed with end-stage renal disease or Lou Gehrig’s disease (ALS).

There are currently no income and asset limitations to Medicare.

Medicaid Eligibility

While the parameters of Medicaid are federally set, each state has the ability to set their own rules within said guidelines. And sometimes, even within the same state, there are a variety of pathways to Medicaid that also have their own requirements.

Dual Eligibility Benefits

Individuals enrolled in both Medicaid and Medicare could receive greater healthcare coverage and have lower out-of-pocket costs. Medicare is typically the primary payer for medical expenses and hospitalization. If Medicare doesn’t cover the full cost, however, Medicaid (the secondary payer) will often cover the remainder. Additionally, Medicaid does cover some expenses that Medicaid does not, including:

Personal care assistance (in-home & community-based)
Long-term skilled nursing home care

Some Medicare Advantage plans sometimes cover the cost of long term care services and supports that Original Medicare doesn’t cover and Medicaid has limitations on. Additionally, Medicaid can sometimes help cover the costs of Medicare premiums, deductibles, and co-payments.

How to Apply for Dual Eligibility

To apply for Medicare, contact your local Social Security Administration office. To find out if you’re eligible for Medicaid and to apply, contact your state’s Medicaid agency.

Let us Help You Navigate the Complexities of Medicare

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