Medicare and Medicaid Dual Coverage
Guess what? You may be eligible to receive both Medicare and Medicaid coverage! If you have limited income and resources, you may qualify for Medicaid, help in paying for your the premiums, and out-of-pocket medical expenses.
For information on qualifying monthly income limits for dual coverage, go to http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Population/Medicare-Medicaid-Enrollees-Dual-Eligibles/Seniors-and-Medicare-and-Medicaid-Enrollees.html
When a Medicare beneficiary begins receiving Medicaid benefits, they are referred to as a Dual Eligible. Dual Eligibles have more extensive benefits. Medicare is the primary insurer so you are allowed to see Medicare providers; you are not limited to Medicaid doctors. Medicaid is considered the secondary insurer and coverage extends to expenses not covered by Medicare. This includes nursing facility care beyond the 100-day limit or skilled nursing facility care that Medicare covers, prescription drugs, eyeglasses, and hearing aids. Services covered by both programs are first paid by Medicare with Medicaid filling in the difference up to the state’s payment limit.
Medicaid Coverage for Medicare Enrollees is as follows:
If you are a dual eligible, your Part B Medicare premium and Part D prescription premium are paid/subsidized. Co-pays for prescriptions medicine reduce to $1 and $5. And depending on your personal circumstances, Medicaid may also provide long-term care services.
Program of All-Inclusive Care for the Elderly (PACE) Benefits
Ever heard of the Program of All-Inclusive Care for the Elderly (PACE)? It provides comprehensive long term services and supports Medicaid and Medicare enrollees. Healthcare professionals work on your behalf to coordinate all of your care needs now and into the future. And in most cases you can usually receive care at home. The focus of every PACE organization is to help you live in the community for as long as possible. Care may also offer services in your community or at one of their centers. PACE centers meet state and Federal safety requirements and include adult day programs, medical clinics, activities, and occupational and physical therapy facilities. If an enrollee does need nursing home care, the program pays for that too and continues to coordinate your care. You are not contractually bound so can leave the program at any time if you so choose.
To be eligible, you must be:
The PACE model of care uses Medicare and Medicaid funds to cover all of your medically-necessary care and services. You can have either Medicare or Medicaid or both to join PACE. This enables states to provide PACE services to Medicaid beneficiaries as state option.
Follow the below link for a list of PACE programs by state: http://www.npaonline.org/website/download.asp?id=1741&title=PACE_in_the_States
Or if you prefer, search for PACE programs in your state at: http://www.npaonline.org/custom/programsearch.asp?id=209
Services include but aren’t limited to the following:
PACE also covers all other services determined necessary by your team of healthcare professionals to improve and maintain your overall health.
If you have a limited means of transportation, PACE organizations provide all medically-necessary transportation to a PACE center for activities or medical appointments. You can even get transportation to other appointments in the community.
If you qualify for Medicare, all Medicare-covered services are paid for by Medicare. If you also qualify for your State’s Medicaid program, you will either have a small monthly payment or pay nothing for the long-term care portion of the PACE benefit. If you don’t qualify for Medicaid you will be charged a monthly premium to cover the long-term care portion the PACE benefit and a premium for Medicare Part D drugs. However, in PACE there is never a deductible or copayment for any drug, service, or care approved by your team.
Detailed information can be found at cms.gov Programs of All-Inclusive Care for the Elderly (PACE) (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/pace111c06.pdf) or call Medicare at 1-800-633-4227.
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