Medi-Medi Dual Eligibility

Learn What You’re Eligible For

Let’s start with the basics and explain Medicaid and who’s eligible for both.

What is Medicaid?

Medicaid is a joint federal and state program that helps pay medical costs if you have limited income and resources and meet other requirements. Some people qualify for both Medicare and Medicaid and are called “dual eligible.” This is also referred to as “Medi-Medi.”

Are You Eligible for Both?

Medicaid programs vary from state to state and may also have different names, like “Medical Assistance” or “Medi-Cal.” Plus, each state has different income and resource requirements and in some states, you may need Medicare to be eligible for Medicaid.

If you’re not sure about your eligibility, we can help. We’ll also answer your questions about how much health insurance coverage you need for your specific situation, and where to get it. In a single phone call, a SeniorQuote Licensed Agent will help you understand what you qualify for then shop more than 30 carriers to get you the right insurance plan.

What does Medicaid cover?

If you have Medicare and full Medicaid coverage, most of your health care costs are covered. People with Medicaid may get coverage for services that Medicare doesn’t cover or only partially covers, like nursing home care, personal care, and home- and community-based services. Also, with Medicare and full Medicaid coverage, Medicare covers your Part D prescription drugs. Medicaid may cover some drugs and other care that Medicare doesn’t cover.

You can get your Medicare coverage through Original Medicare or a Medicare Advantage Part C Plan (like an HMO or PPO).

Dual Eligible Special Needs Plans (D-SNP)

Dual eligible Special Needs Plans (D-SNP) are available to those who meet certain criteria. These plans help cover all or some of the cost sharing for medical benefits and always include prescription drug (Part D) coverage.

In addition, many plans will offer benefits that are not generally covered by either Medicare or Medicaid. These benefits may include dental plans, corrective vision coverage for exams and eyeglasses, additional podiatry benefits, hearing exams, hearing aids and fittings, and transportation to and from medical appointments.

Most of these plans operate within a coordinated care network, either a PPO (Preferred Provider Organization) or HMO (Health Maintenance Organization).

Okay, Now What?

It can be difficult finding all the information you need, understanding the finer details, sorting through your options then determining if you are eligible for both Medicare and Medicaid.

It’s your health, so it’s really important to get it right.

Let’s do this together!

Why not make it easier on yourself? Call a SeniorQuote Licensed Agent today to help you make the right choice.

Avoiding Late Penalties

Don’t let them catch you by surprise!

There are three penalties associated with Medicare Part A, Part B and Part D and they all kick in for the same reason: You didn’t sign up when you were first eligible. Which means it will cost you more money longer term. Let’s unravel this together:

Part A Penalties

If you aren’t eligible for premium-free Part A, and you don’t purchase it when you’re first eligible, your monthly premium may go up by 10%. You’ll have to pay the higher premium for twice the number of years you could have had Part A, but didn’t sign up. For example:

If you were eligible for Part A for two years but didn’t sign up, you’ll have to pay the higher premium for 4 years.

Part B Penalties

If you don’t sign up for Part B when you’re first eligible, or if you drop Part B and then get it later, you may have to pay a late enrollment penalty for as long as you have Medicare. Your monthly premium for Part B may go up by 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it. For example:

Mr. Smith’s Initial Enrollment Period ended September 30, 2010. He waited to sign up for Part B until March 2013 during the General Enrollment Period. His Part B premium penalty is 20%. (While Mr. Smith waited a total of 30 months to sign up, this included only 2 full 12-month periods.)

Part D Penalties

For Part D, the late enrollment penalty is an amount added to your Medicare Part D premium. You may owe a late enrollment penalty if at any time after your initial enrollment there’s a period of 63 or more days in a row when you don’t have Part D or other creditable prescription drug coverage. The cost of the late enrollment penalty depends on how long you didn’t have creditable prescription drug coverage. The formula used to calculate the penalty is based on the “national base beneficiary premium” which may increase every year, which means your penalty would also increase each year. This may impact your monthly premium for as long as you have a Medicare drug plan.

When should I sign up for Medicare?

There is a seven month period when you can sign up for Part A and/or Part B. It starts three months before your 65th birthday month and ends three months after your 65th birthday month.

Example: Turning 65 on May 15

• Let’s say you are turning 65 on May 15: You would enroll anytime during February, March or April in order to have coverage May 1 with no late penalties.
• While your enrollment period allows you to sign up anytime during May, June July or August, the start date for your Medicare coverage will be delayed, so be sure to sign up before the month of your birthday!

Bottom line: Don’t delay

Sign up for Medicare when you are first eligible. Don’t let indecision stop or delay you. If you are unsure which plan is right for you, or if you have questions about a Medicare Supplement plan, Medicare Advantage Plan or Part D prescription drug plan, call a SeniorQuote Licensed Agent today. We can help you navigate through the complexity of health insurance, explore all your options, and get you the coverage you need at a price you can afford.

With SeniorQuote you have the Power to Choose and Freedom to Save.

Understanding Medicare

What is Medicare?

Medicare is a nationwide federal health insurance program for people who are 65 or older. It also covers younger individuals with disabilities and those meeting certain criteria. Most people become eligible for Medicare coverage when you turn 65 years old.

So, if you are approaching age 65, congratulations! Life has never been better for older Americans! And to make sure you enjoy life to the fullest, having adequate health insurance coverage is essential. While understanding it all can be tricky, SeniorQuote can help you make the right choices.

If you’re not yet enrolled in Medicare, we can help you understand what Medicare does or doesn’t cover, what additional insurance options you have, how to cover prescription drugs, and more. We’ll help you make smart decisions about your healthcare coverage.

If you are already enrolled in Medicare, SeniorQuote can help you make the most of it with information about how to use the Annual Enrollment Period and other special election periods to your advantage, how Medicare Supplement insurance can cover costs that Medicare doesn’t and how to save money by avoiding late penalties.

Let’s start with the basics. There are four parts to Medicare:

MEDICARE PART A

Part A is designed to help pay for in-patient hospital care, some home-health services, skilled nursing care, and hospice care. You are eligible to receive Medicare Part A on the first day of the month that you turn 65. Happy Birthday!

In most cases, Part A is premium-free. You will not have to pay a premium for Medicare Part A if you or your spouse paid Medicare taxes for over 10 years.

But Part A doesn’t cover everything.

That’s why having a Medicare Supplement Plan can be so important! It will protect you and your family from the high costs of healthcare.

Remember to sign up for Part A as soon as you become eligible to avoid potential late penalties.

MEDICARE PART B

Part B is designed to help you pay for out-patient hospital care, physician services, and other medical services not covered by Part A.

Together, Part A and Part B are referred to as Original Medicare. Part B coverage is optional and can be purchased from the federal government, if you are 65 or over. Many who choose Part B coverage pay a monthly premium that’s usually deducted from their Social Security benefit checks.

MEDICARE PART C

Often referred to as a Medicare Advantage Plan, Part C is provided by private healthcare companies approved by Medicare. These Part C plans cover all services under Part A (Hospital Insurance) and Part B (Medical Insurance) and sometimes other benefits such as vision, hearing, dental, and health and wellness programs when you use their network of providers.

Part C plans include HMOs, PPOs, and Private Fee for Service Plans, among others. Individuals under a Part C plan usually have a schedule of co-payment and co-insurance costs (called cost-sharing) for covered services with physicians and hospitals within the plan’s network.

MEDICARE PART D

Medicare Part D is designed to help pay for prescription drugs and is also available through private healthcare providers. Part D is frequently included in Part C Medicare Advantage plan coverage, so if you want drug coverage and it’s offered by your Medicare Advantage Plan, in most cases you must get it through that plan.

However, if your plan doesn’t offer drug coverage, you may be able to join a Medicare Prescription Drug Plan

MEDICARE SUPPLEMENT

Centers for Medicare & Medicaid Services (CMS) regulates other miscellaneous programs including:

• Medicare cost plans (which are only offered in a limited number of states)
• Medicare supplemental insurance (Medigap Plans)

Medicare Simplified.

A, B, C, D …What is Medicare? See the links below for more information:

Open Enrollement | Late Penalties | “Medi-Medi” Dual Eligibility | Medigap or Medicare Advantage