Insurances That Are Affiliated with Medicare and Medicaid for Dual Eligibles

For dual eligibles, having the right insurance can make all the difference in accessing quality healthcare. Medicare and Medicaid are two popular insurance options that often go hand-in-hand for individuals with low income or disabilities.

Medicare is a federal health insurance program for people 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.

Medicaid, on the other hand, is a joint federal-state program that provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.

Many states offer a combination of both Medicare and Medicaid, known as dual eligibility, which can provide more comprehensive coverage for those who qualify.

In New York State, the NYSDOH has a priority to promote integrated care for Medicaid members who are dually eligible for Medicare and Medicaid. This is outlined in the New York State Dual Eligible Integrated Care Roadmap.

To be eligible for certain plans, you must meet specific requirements. For example, to enroll in the MAP plan, you must be 18 years or older, have full Medicaid, and be eligible for Medicare Parts A and B. You must also need at least 120 days or more of long term care services and supports.

The MAP plan allows you to remain in the community in your own home while receiving your Medicaid and Medicare services. This is in contrast to other options that may require you to leave your home for care.

Medicare Supplement Writers offer a range of plans to individuals and groups, but the specifics can vary.

There are several companies that write Medicare Supplement Insurance, such as Medicare Supplement Insurance Writers, who offer plans like A, F, G, *High G, and N. If you need to contact them, you can call (800) 601-3372.

For those over 65, individual policy plans are available in A, F, G, *High G, and N. However, group policy plans are not available for this age group.

Under 65 individuals can also purchase these plans, but group policy plans are not an option.

UnitedHealthcare is another company that offers Medicare Advantage plans and Medicare Prescription Drug plans, and you can call them for more information.

Washington National Insurance Company offers customer service by phone at (800) 852-6285 or by email at [email protected].

The Medicare Supplement plans offered by Washington National Insurance Company include A, F, G, *High G, and N for individuals over 65, but group policy plans are not available.

Here is a summary of the Medicare Supplement plans offered by these companies:

Integrated Care Plans for Dual Eligibles are designed to provide you with both Medicaid and Medicare services from the same health plan, helping you meet your health care needs within your own community.

You may be eligible for an Integrated Care Plan if you qualify as a dual-eligible, meaning you have both Medicaid and Medicare. There are three types of Integrated Care Plans in New York, and depending on your care needs, you may be eligible for one of them.

One type of Integrated Care Plan is the MAP (Medicaid Advantage Plus) plan, which pays for all your Medicare health services at little to no additional cost to you and includes benefits such as home care and other long term services and supports (LTSS) you may need.

To enroll in the MAP plan, you must be at least 18 years old, have full Medicaid, and be eligible for Medicare Parts A and B, and you must need at least 120 days or more of long term care services and supports.

Here are the requirements for the MAP and PACE plans:

The PACE (Program of All Inclusive Care for the Elderly) plan also provides comprehensive care services, including home care and other LTSS, and is designed for individuals who are at least 55 years old.

A community health assessment is needed to determine that you meet a certain level of care and that you will continue to need LTSS for more than 120 days to be eligible for PACE.

As a dual-eligible beneficiary, you receive health coverage from both the Federal (Medicare) and State (Medicaid) government. Approximately 9.2 million people are considered to be qualified for "dual-eligible" status in the United States.

You'll have health insurance cards that may look like the ones described, and you'll have the option to choose how you want to get your Medicare coverage. You can pick between Original Medicare or Medicare Advantage (Part C).

As a dual-eligible, Medicare pays first when you get Medicare-covered services, and Medicaid pays last. This means that Medicare covers your prescription drugs, and you'll automatically be enrolled in a Medicare drug plan that will cover your drug costs instead of Medicaid.

Dual eligibility refers to individuals who qualify for both Medicare and Medicaid benefits. Approximately 9.2 million people in the United States are considered to be qualified for "dual-eligible" status.

Dual-eligible beneficiaries receive health coverage from both the Federal (Medicare) and State (Medicaid) government. You'll have health insurance cards that may look like the following, with one card from Medicare and another from Medicaid.

The New York State Department of Health has a plan in place to promote integrated care for Medicaid members who are dually eligible for Medicare and Medicaid. This plan is called the New York State Dual Eligible Integrated Care Roadmap.

The Roadmap outlines the State's priority to improve integrated care options across the State. It was released for public comment on March 3, 2022.

The Office of Health Insurance Programs within the NYSDOH has been working on initiatives to promote integrated care for dual eligible members. These initiatives are designed to improve care coordination and reduce costs.

If you're a dual eligible living in New York, you may be eligible for an Integrated Care Plan. There are three types of Integrated Care Plans, but the specifics depend on your care needs and whether you qualify as a dual eligible.

Here are the three types of Integrated Care Plans:

These plans are designed to help dual eligible beneficiaries meet their health care needs within their own community, instead of going to a nursing home or other facility for care.

Medicaid helps pay for your Medicare Part B (Medical Insurance) monthly premiums. This is a huge relief for many people who might not be able to afford these costs on their own.

Depending on the level of Medicaid you qualify for, your state might pay for other drugs and services that Medicare doesn't cover. This can include a wide range of benefits, but it's always best to check with your state for specific details.

You'll automatically get Extra Help with your drug costs if you qualify for Medicaid. This can make a big difference in your overall healthcare expenses.

Here are some examples of Medicaid-covered expenses and plans:

Medicaid helps pay for your Medicare Part B (Medical Insurance) monthly premiums. This can be a huge relief, especially for those on a fixed income.

Your state might pay for other essential services and medications that Medicare doesn't cover, depending on the level of Medicaid you qualify for.

With Medicaid, you'll automatically get Extra Help with your drug costs. This can be a game-changer for those struggling to afford prescription medications.

Here are some specific expenses that Medicaid may cover:

Medicaid Advantage Plus is a great option for those who qualify, and it's worth understanding what it can help pay for.

Your state will pay your Medicare Part B (Medical Insurance) monthly premiums, which can be a huge relief for those on a fixed income.

Depending on the level of Medicaid you qualify for, your state might pay for other drugs and services that Medicare doesn't cover.

Medicaid may pay for Extra Help with your drug costs, which can significantly reduce your expenses.

Here's a breakdown of what Medicaid Advantage Plus can help pay for:

The PACE and MAP programs are designed to provide comprehensive care to seniors. PACE, the Program of All-inclusive Care for the Elderly, covers Medicare, Medicaid, and Part D prescription drug services.

Serving individuals 55 or older, PACE is based at a social day center that offers a full health care clinic, meals, social activities, and transportation. This setup helps keep individuals independent and living in the community.

A team of professionals coordinates all care and services through PACE, focusing on each individual's needs and preferences.

You must be at least 55 years old to qualify for MAP.

MAP is an integrated managed long term care plan that combines Medicaid and Medicare coverage offered through the same health care organization.

To join MAP, you must also enroll in the plan's Medicare Advantage Dual Special Needs Plan (D-SNP) product.

The plan will take care of all your long term services and supports needs and other health services.

You must choose one of the doctors from the plan to be your Primary Care Provider (PCP).

The plan will cover all Medicaid home care and long term services and supports.

You will also get your Medicare services from the plan.

MAP is a great option for those who need long term care supports and services for more than 120 days.

To find out if you live in a PACE service area, you need to check with New York Medicaid Choice at (888) 401-6582 (TTY users: 1-888-329-1541).

You can also visit a PACE center in your area to see the services they offer. At the center, you can choose to come and benefit from maintenance therapy, social and recreational activities, meals, transportation, and personal care.

At the clinic, you can benefit from a complete, fully staffed health facility with doctors, nurses, and therapists.

Some of the services you can expect to find at a PACE center include:

As of January 1st, 2025, D-SNP plans will be required to provide dental benefits as a Medicare supplemental benefit in New York State.

This change is a result of a new policy from the New York State Department of Health, which aims to improve access to dental care for Medicare recipients.

The FAQs document linked below provides more information on this new policy and what it means for D-SNP plan beneficiaries.

Medicare is a federal health insurance program primarily for people 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

Medicare is divided into four main parts: Part A, Part B, Part C, and Part D. Part A covers hospital stays, skilled nursing facilities, hospice care, and some home health care. Part B covers doctor visits, outpatient care, and some preventive services.

You typically don't pay a premium for Part A if you've worked and paid Medicare taxes for at least 10 years. Part B premiums are usually deducted from your Social Security benefits.