What Does It Mean To Be Dual-Eligible?

Americans who have both Medicare and Medicaid are called dual-eligibles.

Dual-eligibles are eligible or enrolled in both programs when a Medicare enrollee’s revenue and overall capital base are low enough to make them eligible for Medicare support when covering some Medicare costs or making them eligible for comprehensive coverage under both Medicare and Medicaid.

The applicants are usually split into two categories:

Partial duals

Partial duals are enrolled in Medicare, but Medicaid pays some of the expenses accumulated under Medicare. These expenses include Part A and Part B premiums, copayments, coinsurance, and deductibles. Partial duals can qualify for this cost-sharing plan if they are working and disabled and if their income is above Medicaid’s threshold but still below the federal poverty level.

Full duals

By being full dual-eligibles, you will receive Medicaid coverage for services that Medicare will not cover. This includes long-term services and supports. Full duals with lower income and assets will receive full Medicaid benefits and coverage.

Medicare Savings Programs

Dual-eligibles usually fall under one of these four Medicare Savings Programs:

• Qualified Medicare Beneficiary (QMB) Program
  • Monthly income limit: $1,084 for an individual and $1,457 for a couple.
  • Resource limit: $7,860 for an individual and $11,800 for a couple.
  • Covers Part A and Part B premiums, copays, coinsurance, and deductibles.
• Specified Low-Income Medicare Beneficiary (SLMB) Program
  • Monthly income limit: $1,296 for one person and $1,744 for a couple.
  • Resource limit: $7,860 for an individual and $11,800 for a couple.
  • Covers Part B premiums
• Quality Individual (QI) Program 
  • Monthly income limit: $1,456 for an individual, $1,960 for a couple
  • Resource limit: $7,860 for an individual and $11,800 for a couple.
  • Covers Part B premiums
• Quality Disabled Working Individual (QDWI) Program
  • Monthly income limit: $4,339 for an individual and $5,833 for a couple
  • Resource limit: $4,000 for an individual and $6,000 for a couple.
  • Covers Part A premiums for people who are incapacitated yet working

Your state’s Medicaid Eligibility Office can help you determine which program you qualify for.

For all your Medicare and Medicaid questions, contact the agents with Advanced Insurance Concepts at 816-476-8191.