Individuals who qualify for both Medicare and Medicaid are known as dual-eligible beneficiaries. Medicare generally provides their primary health coverage, while Medicaid may provide additional assistance with Medicare premiums, deductibles, copayments, and other healthcare services. The level of Medicaid assistance varies based on eligibility and may include full Medicaid benefits or partial assistance through a Medicare Savings Program (MSP). Understanding these eligibility levels can help beneficiaries identify the Medicare coverage options and assistance programs available to them.
Full Medicaid / Full Dual Coverage: Provides comprehensive Medicaid benefits in addition to Medicare. Depending on the beneficiary's eligibility category and state rules, Medicaid may help cover Medicare premiums and cost-sharing, as well as additional Medicaid-covered healthcare services and benefits.
Covers: QMB benefits plus full Medicaid benefits
Covers: Part B premium plus full Medicaid benefits
Covers: Full Medicaid benefits; exact Medicaid coverage/cost-sharing depends on the state
Partial Medicaid / Partial Dual Coverage: Provides limited financial assistance through a Medicare Savings Program (MSP) to help with certain Medicare costs, such as the Part B premium and, for some beneficiaries, Medicare deductibles, copayments, and coinsurance. It does not provide full Medicaid health coverage.
Covers: Part A/B premiums + Medicare deductibles, copays & coinsurance
Covers: Part B premium
Covers: Part B premium
Covers: Part A premium for certain working disabled beneficiaries
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Medicare and Medicaid eligibility can be confusing, especially when determining how your benefits may affect your Medicare coverage options. Planvesa can help you understand your eligibility, available coverage options, and next steps.
Providing Medicare education, guidance, and plan support.
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