Complete guide for people with both Medicare and Medicaid coverage - maximize your prescription drug benefits
You are "dual eligible" if you qualify for both Medicare and Medicaid. This means you have two types of health insurance working together to provide comprehensive coverage, including significant prescription drug benefits that most Medicare beneficiaries don't receive.
Approximately 12.2 million Americans are dual eligible, representing about 20% of all Medicare beneficiaries. If you're dual eligible, you have access to special programs and benefits designed specifically for people with limited income and resources.
As a dual eligible beneficiary, you have some of the best prescription drug coverage available:
| Benefit | Dual Eligible (You) | Regular Medicare |
|---|---|---|
| Monthly Premium | $0 | $35+ average |
| Annual Deductible | $0 | Up to $590 |
| Generic Copays | $0 - $4.50 | $5 - $47 |
| Brand Name Copays | $0 - $11.20 | $12 - $100+ |
| Coverage Gap | No gap - same low costs | 25% coinsurance |
| Out-of-Pocket Maximum | Very low annual costs | $2,000 maximum |
There are different levels of dual eligible status, each with different benefits:
D-SNPs are Medicare Advantage plans designed specifically for dual eligible beneficiaries. These plans coordinate your Medicare and Medicaid benefits and often provide additional services not available in regular Medicare plans.
Medicaid benefits vary significantly by state, which affects your dual eligible benefits. Some states have expanded Medicaid programs with additional prescription drug coverage and services.
High-Population Dual Eligible States:
If you think you might qualify for dual eligible status, here's how to apply:
As a licensed insurance professional specializing in Medicare and Medicaid coordination, I can help you understand your dual eligible benefits and find the best D-SNP plan for your needs.