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What is Dual Eligible Medicare?

Dual Eligible Medicare

Dual Eligible Medicare

A dual eligible Medicare Beneficiary is enrolled in Medicare and Medicaid. In other words, you are enrolled in either Part A or Part B and getting full Medicaid benefits. According to Wikipedia, approximately 9.2 million people are eligible for “dual” status. Moreover, “Dual-eligibles” make up 14% of Medicaid enrollment and responsible for approximately 36% of Medicaid expenditures.

According to CMS, “Medicare pays covered dually eligible beneficiaries medical services first, because Medicaid is generally the payer of last resort.” As a result, Medicaid may cover medical costs not covered by Medicare. For example, Medicare only covers 100 days in Nursing facility, Medicaid can cover the costs beyond 100 days. There are seven categories for dually eligible beneficiaries and category with the most benefits is QMB Plus.

QMB Plus

Qualified Medicare Beneficiary (QMB) program pays for Medicare Part A, Part B, both premiums, deductibles, coinsurance, and copayments. QMB Plus includes full Medicaid coverage. The QMB benefits and qualifications vary by State. However, Federal law defines Medicaid income standards.

Medicaid Income Eligibility Requirements

Your Medicaid income eligibility depends on where you live. Find out if you are eligible for Medicaid by viewing the 2020 Poverty Guidelines for the 48 contiguous States and the District of Columbia.