Dually Eligible Medicare-Medicaid

Training Information

Understanding Medicare Starts Here is a monthly 15‑minute overview that explains Medicare basics and dual eligibility for people who qualify for both Medicare and Medicaid.

Register for the Medicare in 15 series

Recorded Trainings:

• Required Broker LTSS Training
• Required MA DSNP Care Coordinator Training
• Medicare in 15 Minutes Training
• Medicare 101 Training
• Request a Medicare Training
   

Integrated Care for Dually Eligible Beneficiaries

Medicare – Medicaid Integration

Medicare and Medicaid integration has been an ongoing collaborative effort of the Department of Social and Health Services and the Health Care Authority with the aim to improve access to and participation in integrated care and services in Washington for the dual eligible population (clients on Medicare and Medicaid) through making strategic improvements to the Medicare Advantage integrated Dual Eligible Special Needs Plan program. The goal is sustainable and meaningful transformation in care delivery for the dually eligible population that addresses the whole person through robust care coordination to ensure physical, behavioral and social health needs are being met. DSNPs are also the only Medicare Advantage Plan that have both state and federal regulatory oversight.

What is Medicare

Medicare is a federal health insurance program for people aged 65 or older or under age 65 with certain disabilities. For more Information on Medicare.

Two ways to get your Medicare healthcare coverage
All Medicare beneficiaries have a choice between two options on how they receive their Medicare:

1. Original Medicare is directly through the federal Medicare agency, and enrollment into Medicare is done through the Social Security Administration. 
   Learn more about Enrollment into Medicare.
   Once enrolled in Original Medicare, you have the option to stay with Original Medicare, or you can opt to get your Medicare through a Medicare Advantage Plan.
    
2. Medicare Advantage plans are available through private healthcare plans contracted with the federal government to administer Medicare through a managed Medicare Advantage plan. Medicare Advantage plans cover all benefits that Original Medicare covers in addition to offering supplemental benefits not covered by Original Medicare. 
   To explore Medicare Advantage Plan options available in your area, visit Medicare Plan Finder.

Help Enrolling in Original Medicare or Medicare Advantage
Statewide Health Insurance Benefits Advisors is a free, unbiased service that provides help with all things Medicare. Contact SHIBA at 1-800-562-6900 or online.

Dual Eligible Special Needs Plans

Dual Eligible Special Needs Plans or DSNPs are a subset of Medicare Advantage plans sold by private insurance companies and enroll individuals who are entitled to both Medicare and Medicaid and encompass all categories of Medicaid eligibility. In Washington state, DSNPs are known as Apple Health Medicare Connect. DSNPs offer everything Original Medicare offers and include supplemental benefits and services not covered by Original Medicare. DSNP supplemental benefits are more robust than those of standard Medicare Advantage plans. DSNP Enrollment Information

Dually eligible beneficiaries enrolled in an Apple Health Medicare Connect DSNP will have a Medicare Advantage DSNP card and an Apple Health card in addition to their ProviderOne Services card to take to their medical appointments.

Medicare Savings Programs

How can the Medicare Savings Programs help Medicare beneficiaries?
Medicare Savings Programs is a federal and state program that helps people with limited income pay the costs associated with their federal Medicare health insurance. To qualify for the Medicare Savings Programs, you must be eligible for Medicare and meet the Medicare Savings Programs income eligibility requirement. If a client qualifies, the Medicare Savings Programs can help pay their Medicare Part B premium, deductible, coinsurance and copayments, depending on MSP level.

Apply for Medicare Savings Program

What does it mean to be Full Dual or Partial Dual

Dually eligible people meet the eligibility requirements for both Medicare and Medicaid.

Full, dually eligible beneficiaries have Medicare coverage and, in addition, are eligible for full Medicaid benefits. Partial dually eligible beneficiaries do not meet the income eligibility requirements for Medicaid but may still qualify for some assistance in paying their Medicare Part B premium through a Medicare Savings Program.

Training Information

Understanding Medicare Starts Here is a monthly 15‑minute overview that explains Medicare basics and dual eligibility for people who qualify for both Medicare and Medicaid.

Register for the Medicare in 15 series

Recorded Trainings:

• Required Broker LTSS Training
• Required MA DSNP Care Coordinator Training
• Medicare in 15 Minutes Training
• Medicare 101 Training
• Request a Medicare Training
   

Additional Resources