How Medicaid And Medicare Work Together
Medicaid works to help alleviate costs after Medicare has paid its portion. This means that Medicaid never pays first for your healthcare costs, especially if your Medicare benefits would cover some or all of a particular need or service. After Medicare pays for your doctors visits, surgeries or procedures, any other kinds of health insurance will then kick in. This means if you have an employee or union health package, it will pay second, followed by additional coverage you might have such as a Medigap plan. Medicaid comes in at the end of the process, picking up costs after all other kinds of insurance have paid their portion.
Where Do I Get Started
We know that it can be stressful to navigate the insurance coverage process, but we strive to make it as smooth as possible.
We accept a variety of plans from insurance companies at all of our locations. To verify if your insurance plan is accepted for services across our health system, please review our list of accepted insurance companies below.
If your insurance company is accepted by Cleveland Clinic: Please contact your insurance company to confirm what care is covered by your plan as well as information on copayments, deductibles and coinsurance amounts. See what your out-of-pocket expenses will be using our cost estimator.
If your insurance company is not accepted by Cleveland Clinic: This means your insurance plan is considered out-of-network which can lead to greater out-of-pocket expenses for your care. Please contact your insurance company for more information about what your financial responsibility may be if you choose to receive care at Cleveland Clinic. Find more information about Cleveland Clinics out-of-network insurance process.
Find The Cheapest Insurance Quotes In Your Area
Sometimes, the cost of medical care can keep people from seeking out the services they need, especially in situations where it is difficult enough to keep the lights on or buy groceries.
In these situations, government health insurance programs can help with or even cover the cost of necessary exams, procedures or health screenings to ensure that income does not keep people from being healthy. This is where Medicare and Medicaid come in to provide benefits.
Generally, Medicare is reserved for people close to retirement age or with life-altering disabilities to offer insurance coverage. Medicaid is known for helping low-income families and people with the cost of healthcare regardless of age.
In some cases, you may qualify for both programs something known as being dual eligible.
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Need More Information We Can Help
You can find complete information about dual plans available your area at UHCCommunityPlan.com Or call , TTY 711 from 8 am 8 pm local time, seven days a week. See if a dual plan is right for you.
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare and a contract with the State Medicaid Program.
This information is not a complete description of benefits. Call , TTY 711 from 8 am 8 pm local time, seven days a week for more information.
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Read Also: How Old Before Eligible For Medicare
Distinctive And Enhanced Offerings
We feel best about the plans we put into the marketplace when we know they are rooted in differentiated offerings supported by an exceptional member experience, said Noel. This year, we want our members to know that every expanded benefit, every enhanced program and every investment in a new offering is because we have been listening intently and shaping our plans to deliver on what we hear from consumers.
Added benefits and features that drive distinction for UnitedHealthcare members in 2022 include:
What Are Dual Health Plans
Dual health plans are designed just for people who have both Medicaid and Medicare. Theyre a special type of Medicare Part C plan. Dual health plans combine hospital, medical and prescription drug coverage. Youll keep all your Medicaid benefits. Plus, you could get more benefits than with Original Medicare. And you could get it all with as low as a $0 plan premium.
Also Check: How Much Will Medicare Pay For Nursing Home Care
Is Uhc Dual Complete Both Medicare And Medicaid
UHC Dual Complete includes both Medicare and Medicaid benefits.
UHC Dual Complete plans cover everything found in Original Medicare . That includes both inpatient and outpatient care and durable medical equipment .
As a Medicare Advantage plan, UHC Dual Complete plans can also cover benefits that Original Medicare doesnt cover, such as hearing, vision, dental and prescription drug coverage covered by Medicare Part D.
UHC Dual Complete plans also cover Medicaid benefits, and they coordinate with state Medicaid programs that offer overlapping benefits. In these cases, Medicare is the primary payer and then Medicaid pays second.
Medicaid coverage varies by state, and most Medicaid benefits are covered by Medicare, so the real benefit to these plans as it relates to Medicaid is that most or all of you out-of-pocket Medicare costs can be covered by the plan.
What Are The Benefits Of Unitedhealthcare Dual Complete
In addition to including all of the same benefits as Original Medicare, UHC Dual Complete plans also include a number of benefits not found in Medicare Part A or Part B such as coverage for dental, vision, hearing, prescription drugs, transportation and even things like acupuncture, chiropractic care, over-the-counter health products and gym memberships.
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American Disabilities Act Notice
In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.
What Is Covered By Medicare Vs Medicaid
Depends on the coverage you choose and may include:
- Care and services received as an inpatient in a hospital or skilled nursing facility
- Doctor visits, care and services received as an outpatient and some preventive care
- Prescription drugs
- Medicare Advantage plans: combine Part A and Part B coverage, and often include drug coverage , as wellall in one plan.
Each state creates its own Medicaid program, but has to follow federal guidelines, like the required and optional benefits they include. Some of the benefits Medicaid programs have to include are:
- Care and services received in a hospital or skilled nursing facility
- Care and services received in a federally-qualified health center, rural health clinic or freestanding birth center
- Doctor, nurse midwife, and certified pediatric and family nurse practitioner services
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How Do I Know If I Qualify For Medicaid And Medicare
Twelve million individuals are currently enrolled in both Medicaid and Medicare.1 These individuals are known as dual eligible beneficiaries because they qualify for both programs. As long as you meet the federal qualifications for Medicare eligibility and the state-specific qualifications for Medicaid eligibility, you will qualify as a dual eligible. To qualify for Medicare, individuals generally need to be 65 or older or have a qualifying disability.
There are several levels of assistance an individual can receive as a dual eligible beneficiary. The term full dual eligible refers to individuals who are enrolled in Medicare and receive full Medicaid benefits. Individuals who receive assistance from Medicaid to pay for Medicare premiums or cost sharing* are known as partial dual eligible.
*Cost sharing is the amount of your health care that you pay out of your own pocket. Typically, this includes deductibles, coinsurance, and copayments.
Efforts To Integrate Medicare And Medicaid Benefits
Dual-eligibles typically receive their Medicare and Medicaid benefits through each program separately. For Medicare benefits, beneficiaries may opt to enroll in Medicare’s traditional fee-for-service program or in a private Medicare Advantage plan , which is administered by a Managed Care Organization , under contract with the Centers for Medicare & Medicaid Services , the agency in the Department of Health and Human Services that administers the Medicare program and oversees state Medicaid programs. In addition, dual-eligibles may choose a type of MA plan called a dual-eligible special needs plan , which is designed to target the needs of this population. For Medicaid benefits, beneficiaries generally enroll in their state’s Medicaid FFS program or a Medicaid managed care plan administered by an MCO under contract with the state.
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Understanding The Difference Between Medicare And Medicaid
It is possible to use both Medicare and Medicaid to help with the cost of medical procedures and exams, but you should know how the two programs are different.
Medicare offers health insurance benefits to people who are at least 65-years-old or for people who have disabilities or kidney failure. This kind of insurance is provided by the U.S. federal government and consists of multiple parts that cover different medical needs, such as hospital insurance, medical insurance and prescription medications.
Medicare also offers another option Medicare Advantage Plan that allows people to receive their Medicare benefits through a private insurance company. This avenue allows beneficiaries to customize their health insurance needs.
Medicaid is a state program that helps low-income individuals and families with the costs of healthcare. This is different from Medicare because you do not have to have a disability or be over the age of 65 to receive health insurance benefits.
Medicaids goal is to help people who truly cannot afford the cost of health services because of their income level regardless of age. People who qualify for Medicaid may get assistance paying for premiums, deductibles, coinsurance, copayments, and prescription drugs. And in some cases, Medicaid covers things that Medicare will not, such as the cost of nursing home stays or personal care attendants.
What Does Medicare And Medicaid Pay For
Medicaid is known as the payer of last resort. As a result, any health care services that a dual eligible beneficiary receives are paid first by Medicare, and then by Medicaid. For full dual eligible beneficiaries, Medicaid will cover the cost of care of services that Medicare does not cover or only partially covers . Such services may include but are not limited to:
- Nursing home care
- Dental services
- Eye examinations for prescription glasses
The financial assistance provided to partial dual eligible beneficiaries is outlined in the table above.
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Promoting Optimal Health And Improved Quality Of Life
Individuals of all ages who qualify for both Medicaid and Medicare often live with complex physical, behavioral, and social issues. They are among the nations most chronically ill and resource-intensive patients, and have historically received care in uncoordinated systems which often results in poor quality of care and unnecessarily high costs for states.
AmeriHealth Caritas has developed specialized, proven solutions just for these unique people.
- Medicare Dual Eligible Special-Needs Plans for people entitled to Medicare Part A, enrolled in Medicare Part B, and receiving Medical Assistance for certain categories of aid.
- Medicare-Medicaid Plans for people with full benefit dual Medicare and Medicaid eligibility.
These plans serve individuals who may have cognitive disabilities, physical impairments, or debilitating chronic conditions that make independent living and self-care extremely difficult.
In addition, some dual-eligible beneficiaries qualify to receive long-term services and supports , such as non-rehabilitative, nursing facility-level of care.
What To Consider When Enrolling In A D
You cannot enroll in both a D-SNP and a Health Home program. Enrollment into a D-SNP will disenroll you from your Health Home program. For more information on the Health Home program, see the Health Home page.
You have the option to choose the plan for your D-SNP and BHSO coverage if you live in a county that offers aligned enrollment.
Aligned enrollment helps dual-eligible clients manage their physical and behavioral health services under one plan. This makes it easier to find a provider and coordinate your Medicare and Apple Health services.
View the aligned enrollment map in our service area guide to see if alignment is available in your county.
Dual Plans : Unitedhealthcare Dual Complete Plan Can Bring Additional Benefits
Dual Plans 101: UnitedHealthcare Dual Complete Plan Can Bring Additional Benefits, Convenience to Low-Income Seniors and People with Disabilities
If you interact with people eligible for both Medicare and Medicaid, you should know about an option that could offer a convenient approach to managing their health care.
Whats a Dual-Eligible Special Needs Plan ?
Most of us have heard of Medicare and Medicaid. Medicare provides health benefits for people over age 65 as well as people younger than 65 who qualify due to a disability. Medicaid provides health benefits for people with low income, though eligibility criteria vary by state.
A UnitedHealthcare Dual Complete plan is a DSNP that provides health benefits for people who are dually-eligible, meaning they qualify for both Medicare and Medicaid.
Anyone who meets the eligibility criteria for both Medicare and Medicaid is qualified to enroll in a DSNP. They often face unique health needs and could use assistance improving their health and quality of life. For instance they may:
- Have a disabling condition and struggle with daily activities such as bathing and dressing
- Suffer from a cognitive impairment or a mental disorder
- Receive care from multiple doctors to manage a variety of health conditions or
- Be more likely to need in-home care providers or other health and social services.
Why should someone consider a Dual Complete plan?
How can someone learn more about DSNP?|
What Are The Eligibility Requirements For Uhc Dual Complete
First, you must be eligible for Medicare. That requires being at least 65 years old or having a qualifying disability along with being a U.S. citizen or permanent legal resident.
Next, you must be eligible for Medicaid. Medicaid eligibility varies by state, contains different categories and is based largely on income and assets. Some states also have age restrictions for Medicaid eligibility.
UHC Dual Complete is also available to beneficiaries of each of the four following programs:
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See How Dual Complete Works
Gives people with Medicaid and Medicare more coverage and more support.
You can keep your current Medicaid benefits and well give you more at no extra cost to you.
You could get credits to shop for approved health items.
More dental benefits.
More vision benefits.
And $0 drug copays with home delivery option.
All of this with Dual Complete, a plan that gives you more.
*In HI and AK, 8 a.m. to 8 p.m. Monday through Friday, 8 a.m. to 5 p.m. Saturday and Sunday.Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply. Network size varies by market.1 Based on CMS and Internal Company Enrollment Data August 2021.2 $0 cost-share for in-network dental care, specified services only. If your plan offers out-of-network dental coverage and you see an out-of-network dentist you might be billed more, even for services listed as $0 copay.3 OTC and Healthy Food benefits have expiration timeframes. Call the plan or refer to your Evidence of Coverage for more information.4UnitedHealthcare® HouseCalls may not be available in all areas.5Allowance for contacts or frames with standard lenses covered in full either annually or every two years.
Looking for the federal governments Medicaid website? Look here at Medicaid.gov.
Dental And Vision And Hearing Coverage
Your plan includes embedded dental, vision and hearing coverage. We work with Delta Dental®, an organization that specializes in dental benefits, to make sure you have many providers to choose from and access to top quality care. You can also receive routine eye exams powered by EyeMedSM and routine hearing exams by TruHearingTM.
Read Also: How Much Is Medicare Cost For 2020
Medicare Dual Eligible Special Needs Plans
Another type of coverage that may be available to dual eligible beneficiaries is a Medicare Dual Eligible Special Needs Plan .
A Medicare special needs plan is a certain type of Medicare Advantage plan that is designed for people with specific health conditions or circumstances.
A D-SNP is built for the specific needs of dual eligibles. All Medicare SNPs provide prescription drug coverage.
With Unitedhealthcare Dual Complete Youll Get:
More choice and guidance
- Choose from a wide range of plan options, get answers to your Medicare and Medicaid questions, and understand how to use your benefits.
More value with affordable, high-quality coverage
- Enjoy additional services like routine acupuncture services, yearly check-ups at home to help stay up to date on your health between visits, and much more.4
More access to personalized services and help managing your care
- Get access to our large provider network with no referrals needed and personalized help with coordinating care in the convenience of your own home.
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Historical Challenges With The Dually
Historically, one of the major challenges for the dually-eligible has been care coordination between Medicare and Medicaid. These two systems of care do not “talk to each other” systematically, so one physician that bills primarily through Medicare may not be familiar with benefits that are available through Medicaid. Additionally, since Medicaid benefits vary by state, it is difficult for care providers and consumers to understand the complexity that is inherent within the Medicaid system.
Because duals tend to be the most vulnerable, and often sickest, adults, their care has historically been expensive, totaling $319.5 billion in 2011. One proposed reason for this significant cost would be that many Medicaid programs, prior to the 2010 passage of the Affordable Care Act used a fee-for-service model. Fee-for-service models are typically more costly because they allow providers to charge for the quantity of care they provide, rather than the quality.
In order to resolve these pain points, the ACA includes provisions that specifically address the coverage and care of duals. On a federal level, the Centers for Medicare and Medicaid Services has established two new offices: The Federal Coordinated Health Care Office as well as the Center for Medicare and Medicaid Innovation in order to both strategize and monitor the type and quality of care afforded to duals. These offices focus on both monetary expenses as well as care innovation and quality for dual eligible beneficiaries.