Medicare plans are available for those with both Medicaid and Medicare

If you are enrolled in Medicare and qualify for your State’s Medicaid program, you may have some choice when it comes to a Medicare Plan. Those individuals with both Medicaid and Medicare are considered to be dual eligible. There are Special Needs Medicare Plans available for certain categories of individuals, including those that have both Medicaid and Medicare.

There are three types of Special Needs Plans (SNP’s)

• Dual eligible SNP for those with both Medicaid and Medicare
• Chronic Illness SNP for those with qualifying chronic illnesses.
• Institutional SNP for those confined to a nursing home.

Medicare Drug Plans are included in all Special Needs Plans. If you are dual eligible and have both Medicaid and Medicare, your co-payments will be subsidized and the Medicare Drug Plans generally do not require a monthly premium.

Although many Medicare Advantage Plans offer only Medical coverage, all SNP’s will include the Medicare Drug Plans.

Why consider one of the Medicare Plans if you have both Medicaid and Medicare?

People choose Medicare Plans for many reasons. A Medicare Advantage Plan in not considered a Medigap policy and as such the premium is usually much lower. In the case of a Dual Eligible SNP, if you have full Medicaid benefits from your State, you will generally not pay a monthly premium. You may incur a small amount in the way of cost sharing.

If you have both Medicaid and Medicare, but your Medicaid benefits only allow partial benefits, you may want to discuss your Medicaid status with your agent to make sure a SNP is right for you.

The benefits of choosing a Dual Eligible SNP

• If you have both Medicaid and Medicare, a SNP may allow you more benefits than what you would otherwise have. Many SNP’s include dental, vision, gym memberships (at no cost), as well as transportation benefits to and from medical appointments.
• SNP’s for those with both Medicaid and Medicare are generally network-based plans and may afford you some provider options that you otherwise may not have available.
• If you qualify, you are not subject to the enrollment periods that limit most people who would like to enroll in or change Medicare Plans.
• Medicare Drug Plans are included in the SNP and you will only have to interact with one customer service department, should it be required.

Resources

This information is provided to those who may have both Medicaid and Medicare and are comparing Medicare Plans as well as Medicare Drug Plans.

You can find a wealth of information at the official Medicare website.

For information about Medicaid, visit CMS, the Centers for Medicare and Medicaid services.

Learn about Medicare Advantage for Dual eligible beneficiaries.

Medicare Advantage for those with both Medicare and Medicaid

Many Medicare beneficiaries are also enrolled in their State’s Medicaid program due to having a lower income. Dual eligible Medicare beneficiaries may have access to Special Needs Plans designed especially for them.

If you qualify for a Special Needs Plan (SNP), as a dual eligible Medicare beneficiary, you should enroll in this type of Medicare Advantage plan over any other. Medicare Advantage Plans typically require cost sharing for the member through deductibles, co-payments and co-insurance. These fees may be more than what would be required if you had only Medicare and Medicaid.

Dual eligible SNP benefits

Benefits of enrolling in a Dual Eligible SNP are typically much richer than other types of Advantage Plans. This type of plan is generally a network based plan and not a private fee-for-service plan. Most often there are no deductibles, co-pays or co-insurance as long as the member remains in network.

These plans often include additional benefits, such as transportation to and from doctor visits and the pharmacy. Transportation will generally be limited to a certain number of one way trips. Many plans also include a catalog of health related items as well as vitamins and supplements, that the member may order from and receive either a substantial discount, or in some cases, a quarterly allowed amount to use toward purchases.

Enrolling in a Dual Eligible SNP

Medicare beneficiaries who are dual eligible are not subject to the restrictions of the Annual and Open Enrollment Periods. Dual eligible members can enroll in a SNP at any time during the year. They are also able to change plans at anytime.

If a Medicare plan member qualifies for their State’s Medicaid benefit and they are in a traditional Advantage Plan, they should not wait for the annual enrollment period, as their becoming Medicaid eligible affords them a special enrollment period.

If you are a dual eligible medicare beneficiary and do not have a SNP, you should contact your Advantage Plan’s customer service and ask if they offer a dual eligible plan. If they do not offer a dual eligible plan, you should contact your State’s Medicaid office and ask them for a referral. It’s important that if you are a dual eligible Medicare beneficiary, you have the right plan.

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