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Coordinating two programs

Medicare and Medicaid dual eligibility

Some people qualify for both Medicare and Medicaid. Depending on eligibility and location, a Dual-Eligible Special Needs Plan may coordinate benefits and services.

Who this coverage may be designed for

  • People enrolled in Medicare and a state Medicaid program
  • People receiving a Medicare Savings Program
  • Caregivers helping a beneficiary coordinate benefits

What it generally covers

  • Medicare-covered services
  • Prescription drug coverage in most D-SNPs
  • Plan-specific care coordination and additional benefits

Important limits and enrollment considerations

  • Medicaid eligibility is determined by the state
  • Benefits and cost-sharing levels vary
  • The agent cannot make an official eligibility determination

Ask before you decide

Frequently asked questions about medicare and medicaid dual eligibility

Does guidance cost me anything?

No additional fee is charged to you for O'Neal Insurance Group's guidance. Agents may be compensated by an insurance carrier when an enrollment occurs.

Is every plan available through the agency?

No. The agency does not offer every plan available in every area. Availability depends on location, eligibility, carrier appointment, and product availability.

Can an agent determine my Medicaid eligibility?

No. Eligibility decisions are made by your state Medicaid agency. We can point you to official resources and explain plan options after eligibility is established.

Official resource

Check the source, then ask for personal help

Educational information is general. A licensed agent can help with plan comparisons; agents do not provide medical, legal, or official eligibility advice.

Medicare.gov: Medicare and Medicaid

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