Paying for care
Dual eligible
A dual eligible is a person who has both Medicare and Medicaid. Some have full Medicaid benefits. Others get Medicaid help only with Medicare costs. People with both programs often get coverage for services Medicare does not pay for, such as most long-term services and supports.
Why it matters for your family
For services both programs cover, Medicare pays first and Medicaid pays last. That order can affect who a provider bills. People with full Medicaid and Medicare may qualify for in-home care through a state program, plus their Medicare doctor and hospital coverage. Medicare drug coverage is automatic for many. A common mistake is to think Medicaid replaces Medicare. It does not. Some states offer special plans that combine both. A State Health Insurance Assistance Program counselor can explain the choices for free. Keep both cards, and show both at appointments.
Source: medicare.gov
Related terms
- MedicaidMedicaid is a joint federal and state health coverage program for people with limited income and resources.
- Medicare Advantage (Part C)Medicare Advantage, also called Part C, is a Medicare-approved health plan sold by a private company.
- Medicare Part DMedicare Part D is prescription drug coverage.
- Medicaid eligibilityMedicaid eligibility for long-term care depends on need, income, and assets.
- State Health Insurance Assistance Program (SHIP)A State Health Insurance Assistance Program is a free, state-run counseling service for people with Medicare and their families.
- Medicaid managed long-term services and supports (MLTSS)Medicaid managed long-term services and supports, or MLTSS, is a way states deliver long-term care through managed care plans.
