Understanding Dual Eligibility

Reviewed Jun 2, 2017

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Summary

  • Enrollment in Medicare and Medicaid
  • Coverage range of partial to full benefits
  • Medicaid can help pay Medicare costs

Dual eligibility happens when people are signed up for both Medicare and Medicaid. These people are sometimes called dual eligibles. They are older adults with low wages and younger people with disabilities. They are more likely to have greater health care needs and costs than other people.

Medicare background

Medicare is a federal health insurance program for people aged 65 and older. Younger people with disabilities can also be covered. It pays for hospital stays, nursing home care, and end-of-life care. It also pays for other health needs. Medicare taxes cover most hospital care premiums. Monthly costs for other care services must be paid by the member. A person on Medicare also pays a yearly deductible and part of care costs for a doctor visit or service, called a co-pay. A deductible is what you must pay before Medicare starts paying.

Other health care choices can be found through private companies. These are known as Medicare Advantage Plans. Prescription drug plans can also be found.

Medicaid background

Medicaid was designed to help low-income families and people with disabilities. It is for any age. It helps pay for the costs involved in pregnancies. It also helps with paying for long-term care. Long-term care helps with daily needs like bathing and dressing.

Medicare-Medicaid dual eligibility

Even if they are two unique plans, 9.6 million people count on both. People who are in both programs often have one or more long-term health issue. They can have more ER visits and hospital stays. They are more likely to have disabilities and make less money.

The level of dual coverage can vary greatly, from partial to full benefits. Partial Medicaid benefits pay for Medicare premiums and sometimes also co-payments and deductibles. Full will pay for other costs that are not covered as well. Some examples may include home care, dental and eye care, mental health care and therapy, transportation to and from providers and prescription drug coverage

Medicare-Medicaid Coordination Office

It can be hard for people who are dual eligible to deal with two systems. The Medicare-Medicaid Coordination office was created by the Affordable Care Act. One purpose of the office is to better mix the two programs. One more purpose is to help support between federal and state governments. The desired result is for better health care at a lower cost.

This can be reached by meeting eight goals:

  1. Give full access to benefits
  2. Make getting items and services easier for people
  3. Make better the level of health care and long-term services
  4. Give more knowledge of coverage
  5. Remove conflicts between program rules
  6. Help unify care and make safe and useful care transfers
  7. Make payments fair
  8. Ensure providers of services and suppliers are working as expected

The making of this duals office gives a renewed pledge to blend both programs. This will result in better health care for us all.

By Kevin Rizzo
Source: U.S. Department of Health and Human Services; http://answers.hhs.gov/categories/94; Centers for Medicare and Medicaid Services, www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/medicare_beneficiaries_dual_eligibles_at_a_glance.pdf; www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/index.html; http://kff.org/medicare/state-indicator/dual-eligible-beneficiaries/

Summary

  • Enrollment in Medicare and Medicaid
  • Coverage range of partial to full benefits
  • Medicaid can help pay Medicare costs

Dual eligibility happens when people are signed up for both Medicare and Medicaid. These people are sometimes called dual eligibles. They are older adults with low wages and younger people with disabilities. They are more likely to have greater health care needs and costs than other people.

Medicare background

Medicare is a federal health insurance program for people aged 65 and older. Younger people with disabilities can also be covered. It pays for hospital stays, nursing home care, and end-of-life care. It also pays for other health needs. Medicare taxes cover most hospital care premiums. Monthly costs for other care services must be paid by the member. A person on Medicare also pays a yearly deductible and part of care costs for a doctor visit or service, called a co-pay. A deductible is what you must pay before Medicare starts paying.

Other health care choices can be found through private companies. These are known as Medicare Advantage Plans. Prescription drug plans can also be found.

Medicaid background

Medicaid was designed to help low-income families and people with disabilities. It is for any age. It helps pay for the costs involved in pregnancies. It also helps with paying for long-term care. Long-term care helps with daily needs like bathing and dressing.

Medicare-Medicaid dual eligibility

Even if they are two unique plans, 9.6 million people count on both. People who are in both programs often have one or more long-term health issue. They can have more ER visits and hospital stays. They are more likely to have disabilities and make less money.

The level of dual coverage can vary greatly, from partial to full benefits. Partial Medicaid benefits pay for Medicare premiums and sometimes also co-payments and deductibles. Full will pay for other costs that are not covered as well. Some examples may include home care, dental and eye care, mental health care and therapy, transportation to and from providers and prescription drug coverage

Medicare-Medicaid Coordination Office

It can be hard for people who are dual eligible to deal with two systems. The Medicare-Medicaid Coordination office was created by the Affordable Care Act. One purpose of the office is to better mix the two programs. One more purpose is to help support between federal and state governments. The desired result is for better health care at a lower cost.

This can be reached by meeting eight goals:

  1. Give full access to benefits
  2. Make getting items and services easier for people
  3. Make better the level of health care and long-term services
  4. Give more knowledge of coverage
  5. Remove conflicts between program rules
  6. Help unify care and make safe and useful care transfers
  7. Make payments fair
  8. Ensure providers of services and suppliers are working as expected

The making of this duals office gives a renewed pledge to blend both programs. This will result in better health care for us all.

By Kevin Rizzo
Source: U.S. Department of Health and Human Services; http://answers.hhs.gov/categories/94; Centers for Medicare and Medicaid Services, www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/medicare_beneficiaries_dual_eligibles_at_a_glance.pdf; www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/index.html; http://kff.org/medicare/state-indicator/dual-eligible-beneficiaries/

Summary

  • Enrollment in Medicare and Medicaid
  • Coverage range of partial to full benefits
  • Medicaid can help pay Medicare costs

Dual eligibility happens when people are signed up for both Medicare and Medicaid. These people are sometimes called dual eligibles. They are older adults with low wages and younger people with disabilities. They are more likely to have greater health care needs and costs than other people.

Medicare background

Medicare is a federal health insurance program for people aged 65 and older. Younger people with disabilities can also be covered. It pays for hospital stays, nursing home care, and end-of-life care. It also pays for other health needs. Medicare taxes cover most hospital care premiums. Monthly costs for other care services must be paid by the member. A person on Medicare also pays a yearly deductible and part of care costs for a doctor visit or service, called a co-pay. A deductible is what you must pay before Medicare starts paying.

Other health care choices can be found through private companies. These are known as Medicare Advantage Plans. Prescription drug plans can also be found.

Medicaid background

Medicaid was designed to help low-income families and people with disabilities. It is for any age. It helps pay for the costs involved in pregnancies. It also helps with paying for long-term care. Long-term care helps with daily needs like bathing and dressing.

Medicare-Medicaid dual eligibility

Even if they are two unique plans, 9.6 million people count on both. People who are in both programs often have one or more long-term health issue. They can have more ER visits and hospital stays. They are more likely to have disabilities and make less money.

The level of dual coverage can vary greatly, from partial to full benefits. Partial Medicaid benefits pay for Medicare premiums and sometimes also co-payments and deductibles. Full will pay for other costs that are not covered as well. Some examples may include home care, dental and eye care, mental health care and therapy, transportation to and from providers and prescription drug coverage

Medicare-Medicaid Coordination Office

It can be hard for people who are dual eligible to deal with two systems. The Medicare-Medicaid Coordination office was created by the Affordable Care Act. One purpose of the office is to better mix the two programs. One more purpose is to help support between federal and state governments. The desired result is for better health care at a lower cost.

This can be reached by meeting eight goals:

  1. Give full access to benefits
  2. Make getting items and services easier for people
  3. Make better the level of health care and long-term services
  4. Give more knowledge of coverage
  5. Remove conflicts between program rules
  6. Help unify care and make safe and useful care transfers
  7. Make payments fair
  8. Ensure providers of services and suppliers are working as expected

The making of this duals office gives a renewed pledge to blend both programs. This will result in better health care for us all.

By Kevin Rizzo
Source: U.S. Department of Health and Human Services; http://answers.hhs.gov/categories/94; Centers for Medicare and Medicaid Services, www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/medicare_beneficiaries_dual_eligibles_at_a_glance.pdf; www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/index.html; http://kff.org/medicare/state-indicator/dual-eligible-beneficiaries/

The information provided on the Achieve Solutions site, including, but not limited to, articles, quizzes, and other general information, is for informational purposes only and should not be treated as medical, health care, psychiatric, psychological or behavioral health care advice. Nothing contained on the Achieve Solutions site is intended to be used for medical diagnosis or treatment or as a substitute for consultation with a qualified health care professional. Please direct questions regarding the operation of the Achieve Solutions site to Web Feedback. If you have concerns about your health, please contact your health care provider.  ©2017 Beacon Health Options, Inc.

 

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