White Paper

Stop Settling: Are You Getting Partial Dual Premiums for Full Dual Risk?

Although most of us are aware of Medicare and Medicaid programs, a significant amount of Medicare beneficiaries are still not aware of all the benefits potentially available to them. Medicare recipients, who are low-income and meet other criteria, may qualify to receive full or partial Medicaid benefits. These individuals are referred to as “dually eligible beneficiaries”, “dual eligibles”, or “duals”.

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Dual Eligibility

The term “dual eligible beneficiaries”
refers to those individuals qualifying for
both Medicare and their state’s Medicaid
program. “Partial duals” are members that
qualify for Medicare Savings Programs (MSP) such as QI-1, SLMB, and QMB.

The federal minimum income limit for the
MSP is 135% Federal Poverty Level (FPL);
however, seven states have elected to use higher income limits. “Full duals” are members that qualify for Medicare and full Medicaid benefits available through the Medicaid state plan.

According to Centers for Medicare and Medicaid Services, 12.3 million people were considered dual enrolled in 2020. However, an additional 50% of individuals who meet eligibility standards continue to go unidentified every year.

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