Medicare and Medicaid Dual Eligibility: What You Need to Know

Medicare and Medicaid are two government programs designed to help people to get the health care they need when other options aren’t available. The programs are distinct from one another, but in some cases, a person can qualify for both. This is commonly referred to as being dual eligible. There are over 9 million people in the United State who qualify for dual eligibility. Knowing if you or a loved one is among this number is very important when planning your financial and medical futures.

Who Qualifies

In order to qualify for dual eligibility, one must meet the necessary requirements for each program. Medicaid is generally reserved for those with low or no-income. Medicare is a program designed for those who are aged 65 or older (in most cases). So, most people who qualify for dual eligibility will be over the age of 65 and have either no income, or a low level of income available.

Medicare is the Primary Payer

It is important to know that Medicare is considered the primary payer in most situations. This means that when there is coverage from both programs for a particular treatment, Medicare should be billed first. If there is any type of out of pocket expense, however, Medicaid may pay for the remaining balance. This will depend on the specific treatment or service in question.

Complimentary Coverage

One of the biggest benefits of being eligible for both of these programs is that they often provide complementary coverage. Medicaid, for example will cover most expenses associated with long term care facilities, which Medicare typically doesn’t.

Challenges to Be Aware Of

Qualifying for dual eligibility can help to ensure you or your loved one has access to the medical care they need. There are many great benefits to being enrolled in both programs, but there are also some challenges that should be noted. First, many health care providers don’t really understand the specifics of how dual eligibility works. This can result in bills being unpaid, or being improperly sent back to the patient. When this happens, the patient or their loved ones need to make sure to reach out to the proper program administrator to ensure everything is paid properly.

Get the Help You Need

If you or a loved one may qualify for dual eligibility, you will want to speak with an attorney to make sure everything is handled correctly. As with many government programs, the benefits are great, but they aren’t always as easy to access as they should be. Having an experienced attorney who can help ensure everything is done properly can help to streamline qualifications, and ensure all benefits are received in a timely manner. Contact ProActive Legal Care to talk about your situation and get the process started today.

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