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Learn » Medicare Advantage » Medicare Advantage and Medicaid: Choosing a Dual-Eligible Part C Plan

Medicare Advantage and Medicaid: Choosing a Dual-Eligible Part C Plan

Using your dual-eligible status to get Medicare Advantage is a winning idea.

February 13, 2019 - By Bud Scannavino - read

Researched by licensed + unbiased insurance experts. Learn More

Once you’ve got both Medicare and Medicaid, you don’t have to stop looking for benefits. Many Medicare Advantage plans add even more support for dual-eligible people.

If you have dual eligibility – meaning you make use of Medicare and Medicaid at once – then you may prefer the benefits of a Medicare Advantage plan (also known as Medicare Part C).

What Are Dual Eligible Medicare Advantage Plans?

Medicare Advantage (Medicare Part C) is an alternative way to receive your Medicare health benefits.

Extremely popular throughout the country, these plans typically combine your hospital, doctor and prescription drug benefits into a single health insurance policy. You will recognize these plans by the combination of letters around their names: think HMO, PPO, RPPO, and MA-PD. Tens of millions of people, including those without Medicaid, are enrolled in these plans.

Some Medicare Advantage plans are specifically designed to work hand in hand with Medicaid. Therefore, these plans are called dual-eligible Medicare Advantage plans.

Here are five reasons you might want a dual eligible Medicare Advantage plan of your own.

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1. More Doctor Choices Compared to Medicaid

If you want to use your Medicaid coverage with Medicare, then you’ll have to find doctors who accept Medicaid payment. And if you see doctors who take Medicare but not Medicaid, then you’ll have to pay the full deductibles and coinsurance under the terms of Original Medicare (Part A and Part B).

Paying non-Medicaid doctors could immediately empty your pocket. For that reason, many people on Medicaid choose to replace their Medicare + Medicaid hassle with a dual-eligible Medicare Advantage plan.

With a Part C plan, you’ll have access to doctors who work with a Medicare Advantage company – even doctors who don’t accept Medicaid payment.

When visiting those Medicare Advantage professionals, you’ll only have to pay what Medicare Advantage asks you to pay for care (typically a small copayment). And unlike Original Medicare, your spending will have the safety of an out-of-pocket spending limit each year.

In other words, you’ll be able to see doctors who accept a certain insurance company. This is a very attractive option if you want to see certain doctors who do not take Medicaid. Medicare Advantage plans are run by health insurers with experience creating wide doctor networks.

2. Extra Benefits Beyond Medicare and Medicaid

Combining Medicaid with a Medicare Advantage plan gives you fringe benefits that Medicaid and Medicare do not provide. Depending on the plan you choose, you could receive:

  • Vision care, like eye exams and discounts on eyeglasses or contact lenses
  • Dental benefits, like routine cleanings
  • Discounts on hearing aids
  • Free gym memberships
  • Transportation to and from doctors’ appointments

New Medicare Advantage rules continue to expand the range of benefits that dual-eligible Part C plans can offer.

3. Dual-Eligible Special Needs Plans Can Target Chronic Illnesses

You might have read the common term dual-eligible special needs plan (D-SNP or DSNP) by now. What makes this type of Medicare Advantage plan so special?

“Dual” means the plan is only available to people who have both Medicare and Medicaid, meaning dual-eligibles.

“Special needs” means the you have two or more chronic illnesses that are commonly found together. For example, heart disease and diabetes is a common D-SNP combination.

Joining a Medicare Advantage dual-eligible special needs plan gives you focused access to doctors who specialize in certain illnesses. In some cases you’ll also have a greater choice of prescriptions to treat those illnesses.

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4. Personalized Help From Insurers and Agents Who Care

If you’re only enrolled in Original Medicare and Medicaid, then you’ll have limited personal help from the government.

But if you enroll in a Medicare Advantage plan, then you’ll have a health insurer to guide you as medical needs arise. The health insurance agent who signed you up for Medicare Advantage will be all too happy to give you financial advice as well. Personal assistance can be a great asset in getting all the benefits to which you are entitled.

5. Dual-Eligible Status Gives You Extra Chances to Adjust Your Plan

If you have Medicaid, then your signups for Medicare Advantage are not limited to the Annual Election Period (AEP) at the end of each year. Instead, you’ll have four additional opportunities evenly spaced throughout the year to enroll. Once you compare price quotes online, a licensed agent can set up your policy appropriately.

More opportunities to enroll is an important benefit of your Medicare Advantage dual eligibility status.

Where Can You Find Dual Eligible Medicare Part C Plans?

Your dual-eligible Medicare Advantage choices depend on where you live. The ranges of plans varies by state, county and sometimes even by ZIP code. That’s why it’s best to run a broad online search. From there, a qualified and licensed agent will help you compare plans and understand their benefits.

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