What is Dual Eligibility for Medicare and Medicaid?

People who are eligible for and enrolled in both Medicare and Medicaid are called “dual eligibles” or “dually eligible beneficiaries.” Dual eligibles are a unique group of people, often with many health and social support needs. In 2013, Hawaii had 39,400 people who qualified.

Many people get confused about the differences between Medicare and Medicaid so let’s start with a brief explanation. Both programs offer access to health care services, Medicare is a federal health insurance program for seniors and disabled persons while Medicaid is a state and federal medical assistance program to support people with financial need of all ages. The Centers for Medicare and Medicaid Services (CMS) runs both programs but the Medicaid program is run through state agencies while Medicare is run through the Social Security Administration (SSA).

One of the main benefits differences is that Medicaid provides long-term nursing home care, both in home and in community-based settings. It is important to note that in 2019, Medicare Advantage Plans (Part C) started including some long-term home and community-based benefits.

If you are eligible for Medicaid and will be transitioning to Medicare soon, contact a Medicare agent who can show you your options and help you find the right plan for your needs.

Who qualifies for dual eligibility?

In order to be “dually eligible”, a person must be enrolled in Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance) or a Medicare Advantage Plan (which always includes Medicare Part A and Medicare Part B). In addition, a person must be enrolled in either full coverage Medicaid or one of Medicaid’s Medicare Savings Programs (MSPs) that helps with the cost of Medicare.

What are the benefits of dual eligibility?

There are two potential main benefits to people who are eligible for both Medicare and Medicaid. They are:

1. More healthcare coverage