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How Medicaid works with Medicare

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What makes this a plan for people who are dual-eligible?

Dual Special Needs Plans are for people who could use some extra help. That may be because of income, disabilities, age and/or health conditions. Dual Special Needs Plans are a type of Medicare Advantage plan. Dual Special Needs Plans are also called D-SNP for short. These names all mean the same thing. 

How does dual coverage health insurance work with both Medicaid and Medicare?

A Dual Special Needs Plan works together with your Medicaid health plan. You’ll keep all your Medicaid benefits. Most dual health insurance plans also give you more benefits and features than you get with Original Medicare. All with as low as a $0 plan premium.

More help for you

Care coordination is another big benefit you get with a Dual Special Needs Plan. You’ll have a personal care coordinator. That’s someone who can help you:

  • Understand your Medicaid and Medicare benefits.

  • Manage your doctors, specialists and care services.

  • Get the services you need to feel as healthy as you can.

Dual-Eligible Plans May Include:

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Some Plans in 2024 Include:

$3,912    Health Food and OTC Card

$4,000    Dental, including Dentures

$3,500    Hearing and Hearing Aids

$450       Glasses

48           Routine Transportation Rides

$0.          Tele medicine

$0.          Drug Copay

Companies Participating in Dual-Eligible Plans 


Dual-Eligible Explained:


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Are prescription drugs covered by dual health plans? 

Dual eligible health plans include more prescription coverage than Medicaid or Original Medicare alone. See a list of drugs covered by dual health plans available where you live. Worried about the high cost of prescription drugs? You’re not alone. Many people who rely on medicines wouldn’t be able to pay for them out of pocket. So it’s no wonder that prescription drug coverage is one of the first things people ask about dual health plans. These plans are for people who have both Medicaid and Medicare. And this article covers the prescription drug coverage that dual health plans typically include.

Vision coverage: Take a closer look at what dual health plans offer.

Vision care coverage options are explained to help you fully understand what vision care is covered in health plans for people who have both Medicaid and Medicare. If you have Original Medicare, you may have already found out that it doesn’t cover eye exams. If you need an exam for eyeglasses or contact lenses, you’d have to pay for it yourself. But with a dual health plan, you could get vision coverage.* Dual health plans are for people who have both Medicaid and Medicare. Most dual health plans cover vision services, so they cover more of your care and costs.Getting your vision checked regularly is important for everyone. That’s why dual health plans usually include routine eye exams as part of vision care coverage. But some dual health plans go beyond basic coverage and also give you hundreds of dollars in credits to help pay for eyewear. That could go a long way toward helping pay for a stylish new pair of glasses. Or you may be able to choose contact lenses if you prefer.

Dental coverage gives people with Medicaid and Medicare more to smile about.

See a breakdown of the parts of dental coverage, so you know what to think about for dental care coverage when you have both Medicaid and Medicare. 

Good dental health is important, because it has so much to do with your overall health. But dental care can also be very expensive. When money is short, it may be tempting to put off or skip going to the dentist. 

Routine dental care is not covered by Original Medicare. Medicare Part A (Hospital Insurance) will only pay for dental services that you get when you're in a hospital. If you need to have emergency dental care during a hospital stay, Medicare may cover your dental care, but otherwise not.

Medicaid covers dental services for children, and certain states also provide comprehensive Medicaid dental coverage for adults. But the rules for Medicaid dental coverage are different for each state. Except for emergency dental care, what other dental services are covered by Medicaid depends on where you live.

If you have both Medicaid and Medicare, you may not have to make that choice. Dual health plans are for people who have both Medicaid and Medicare. And most include dental coverage.* That could make a big difference to your budget and your health. 

Before you enroll in any health plan, it’s good to know exactly what the benefits and coverage mean. Here are different types of dental care that you may want to make sure are covered by your plan:

Regular exams and cleanings. Most dual health plans include $0 copays for regular exams, which can include cleaning and periodontal maintenance. That means you can visit the dentist for a cleaning at no extra cost to you.

Dental X-rays. Dentists use x-rays to get a detailed look at the health of your mouth. They can check the roots of your teeth and surrounding bones, as well as fillings, crowns and implants. X-rays also help dentists find decay and cavities.

Fluoride treatments. It’s a quick, painless way to help protect your teeth from cavities and decay.

Credits for dental services. Usually, patients pay part of the cost for fillings, root canals, implants and other dental services. But many dual health plans include credits to help pay for these types of dental services. Some dual health plans even include credits for dentures.

Keep your smile.

Our teeth are a big part of how we look. And it may be a lot easier to feel good about yourself when you feel good about your teeth. Having a nice smile can improve your self-confidence. And that may make it easier and more enjoyable to socialize too. Don’t miss out on getting dental coverage if you qualify for Medicaid and Medicare, see what dental coverage you could get with a dual health plan.

The coverage gap or "Donut Hole"​ does not apply to those with Medicaid

To learn more about this and other Health related topics, talk with a professional in your community. Make an appointment to speak with one of our professionals and see for yourself the Elkin Insurance difference. At Elkin Insurance "We Care About You".

Call: 336-366-0960

How a dual-eligible health plan (D-SNP) can help people with diabetes 

Dual-eligible health plans offer many extra benefits that can help make managing diabetes easier and help cover the cost of diabetes supplies and healthy food.

A Navigator can help make life easier for dual health plan members.

What does it mean to have a dedicated Navigator and what do Navigators do to help make it easier for people who are dual-eligible for both Medicaid and Medicare to get support?

A dual health plan could help you buy healthy food at no cost.

Dual benefits for people with both Medicare and Medicaid include the healthy food benefit from UnitedHealthcare which gives you credits to buy food at no cost. 

Good food is important for good health. But eating healthy can be hard on a limited budget. Knowing this, UnitedHealthcare created a new health benefit called “healthy food.” Like the name says, the healthy food benefit helps people buy healthy food. It’s included with most UnitedHealthcare dual health plans for 2021.

Dual health plans are for people who qualify for both Medicaid and Medicare. Healthy food is one of many

extra dual benefits you could get with a dual health plan. See all the other benefits dual health plans may offer.

Telehealth is a useful benefit of many dual health plans.

Telehealth and telemedicine can help make it easier to get treated by a doctor at no cost to you. It’s not always easy to visit a doctor in person. And it’s not only people with Medicaid and Medicare who may find it hard to drive to the doctor or get a ride. If it’s after normal business hours, your regular doctor may not be available. That’s when telehealth can help. Read on to find out how telehealth works and when to use it.

Dual health plans usually include transportation assistance at no cost.

For people who have both Medicaid and Medicare, a dual health plan may provide rides at no cost to take care of your health needs. Get rides at no cost to you. If you’re in poor health or have a disability, it can be hard to get around. And if you don’t have a car, or live outside town, getting to care appointments can be a challenge. That’s why dual health plans usually include transportation assistance. Dual health plans are for people who have both Medicaid and Medicare. These plans include many extra benefits and features to help make life easier.

You typically get a set number of one-way rides to health appointments at no cost to you.

A dual health plan could help you get aspirin, vitamins and many other items at no cost

If you have both Medicaid and Medicare, see how you could get credits to buy aspirin and many other health-related items at no cost with a dual health plan. Have you ever needed something at the drug store, but you couldn’t afford it? That’s a tough situation, but it’s one some people with low income know all too well. Dual health plans are for people who have both Medicaid and Medicare. These plans include many extra benefits

and features to help make life easier. One of the most popular benefits is being able to get over-the-counter drugs and other health items at no cost. That can help make a big difference to both your budget and your health.​

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