Ocasio Group

📞 (305) 306-0504

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    • Dual Enrollment Explained
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    • Home
    • For Providers
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    • Resourses and Support
      • Medicare Basics
      • Healthcare Resources
      • Dual Enrollment Explained
Ocasio Group

📞 (305) 306-0504

  • Home
  • For Providers
  • For Agents
  • Contact
  • Resourses and Support
    • Medicare Basics
    • Healthcare Resources
    • Dual Enrollment Explained

Dual Enrollment Explained

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 Dual Benefits

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.

QMB+: Qualified Medicare Beneficiary Plus

🟢 Full Medicaid

Covers: QMB benefits plus full Medicaid benefits

SLMB+: Specified Low-Income Medicare Beneficiary Plus

🟢 Full Medicaid

Covers: Part B premium plus full Medicaid benefits

FBDE: Full-Benefit Dual Eligible

🟢 Full Medicaid

Covers: Full Medicaid benefits; exact Medicaid coverage/cost-sharing depends on the state


Partial Dual Benefits

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.

QMB: Qualified Medicare Beneficiary

🟡 Partial Medicaid

Covers: Part A/B premiums + Medicare deductibles, copays & coinsurance

SLMB: Specified Low-Income Medicare Beneficiary

🟡 Partial Medicaid

Covers: Part B premium

QI: Qualifying Individual

🟡 Partial Medicaid

Covers: Part B premium

QDWI: Qualified Disabled & Working Individual

🟡 Partial Medicaid

Covers: Part A premium for certain working disabled beneficiaries

Add a footnote if this applies to your business

Need Help Understanding Your Medicare & Medicaid Options?

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.

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