Medicare is a national health insurance program run by the federal government. It’s for people age 65 and older, and also some people under age 65 with certain disabilities.
Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is funded jointly by states and the federal government. Medicare is a federal program. It provides coverage for people age 65 and older, and also some people under age 65 who qualify due to a disability.
Medicare Advantage Plans (also known as Medicare Part C) offer an alternative to Original Medicare (also known as Medicare Parts A and B). Medicare Advantage (MA) Plans replace your coverage under Parts A and B, and sometimes include additional coverage. They often (but not always) include a specific network of doctors and health care providers you can use to get care, sometimes at lower costs.
Dual special needs plans (also called dual health plans or DSNPs for short) are for people who qualify for both Medicare and Medicaid. A dual health plan works together with your Medicaid health plan. You’ll keep all your Medicaid benefits. Dual health plans cover eligible doctor visits, hospital stays and prescription drugs. For people who qualify, a dual health plan may offer more health benefits than with Original Medicare and a separate Part D plan.
Dual health plans:
(Even if you do have a premium — that’s the amount you pay for insurance — you may qualify for low-income subsidies to help with the cost.)
Dual health insurance plans offer benefits and services not typically available through Medicare or Medicaid. With a dual health plan, you'll keep your Medicaid benefits, and you’ll get more benefits than Original Medicare at no extra cost.
UnitedHealthcare dual health plans include a wide range of extra benefits and features.*
Our plans may cover:
Some dual health plans also include care coordination. That's a big help — especially for people who have complex medical needs. It makes it easier to manage your doctors, specialists and care services.
* Please note that the dual plans UnitedHealthcare offers, and the specific benefits they include, can change depending on where you live. For details about the dual plans available in your area, please use the search feature on our home page at UHCCommunityPlan.com.
Yes. Some people qualify for both Medicare and Medicaid. These people qualify for Medicare due to age (by being age 65 or older) or because they have a disability. They also qualify for Medicaid because they meet the Medicaid requirements in their state. People who are eligible for both Medicare and Medicaid are "dual eligible."
"Dual eligible" describes people who qualify for both Medicare and Medicaid at the same time. These people are eligible for both programs, so they’re "dual eligible."
Medicaid is a health care program that's managed at the state level by each state government. However, state governments do not actually provide health insurance. State governments contract with private insurance companies like UnitedHealthcare to provide health coverage for beneficiaries of Medicaid and other government health care programs. Our government-sponsored health plans operate under the name UnitedHealthcare Community Plan.
UnitedHealthcare health plans are offered by United Healthcare Insurance Company. We (and other private insurance companies) work with federal and state agencies to provide government-sponsored health insurance. We are not part of Medicare. We work with the Centers for Medicare & Medicaid Services (CMS) and many state governments to provide health coverage for Medicare and Medicaid recipients.
You'll need to apply through the state agency that manages the Medicaid program in your state. For questions, or to see what health plans UnitedHealthcare Community Plan offers in your area, please use the search feature on our home page at UHCCommunityPlan.com.
When you apply for Medicaid, you'll need to fill out an application form. Different states have different requirements for Medicaid. You'll likely need to have various documents, such as:
In all states, Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states, Medicaid covers all low-income adults below a certain income level.
The exact requirements to qualify for Medicaid depend on where you live. To find out if you're eligible for Medicaid in your state, visit the website for Medicaid in your state. Then check the eligibility requirements.
You'll find a link to the website for your state Medicaid agency on the "Plan Details" page for each health plan UnitedHealthcare Community Plan offers. To see the plans available in your area, please use the search feature on our home page at UHCCommunityPlan.com.
The Affordable Care Act created a new office within the Centers for Medicare & Medicaid Services (CMS). The Medicare-Medicaid Coordination Office makes sure people who are dually enrolled in both Medicare and Medicaid have full access to seamless, high quality health care. The goal is to make the two programs work together more effectively to improve care and lower costs.
Medicaid programs can help Medicare by paying certain Medicare costs. And by covering benefits not offered by Medicare, such as hearing, transportation, vision, dental and long-term care.
Medicare and Medicaid are two separate programs that have different eligibility requirements.
As part of the Affordable Care Act, most states chose to expand Medicaid coverage to include all low-income adults under age 65. Other states may choose to do so at any time. Many people are surprised to find out they qualify. That's why it's always good to check.
To see if you're eligible for Medicaid in your state, visit the website for Medicaid in your state. Then check the eligibility requirements.
You are under age 65 and meet the requirements for low-income families, pregnant women and children, individuals receiving Supplemental Security Income (SSI), disability or other special situation.
A UnitedHealthcare licensed sales agent can tell you if you live in our service area. Or, to see the plans available in your area, please use the search feature on our home page at UHCCommunityPlan.com.
Most likely, you won’t be able to qualify for a dual plan if you have end-stage kidney failure, also called end‑stage renal disease (ESRD). If that’s the case, please talk with a UnitedHealthcare licensed sales agent to discuss your specific situation.
Effective January 1, 2020 DSNP's will no longer have unlimited special enrollment period. Enrollment changes will be effective the first day of the next month.
NOTE: It's important to remember that to stay eligible for a dual health plan, you must recertify for Medicaid every year. As long as you stay eligible, your dual health plan will renew automatically each year.
No. Referrals are not needed to get care from any in-network doctors, hospitals or clinics.
If you're enrolled in a UnitedHealthcare dual plan and you lose your Medicaid eligibility, we'll put you on hold for 6 months. During this time, you'll have to pay the Medicare cost-sharing portion such as copayments, coinsurance, deductibles and premiums. If you don't regain your Medicaid eligibility at the end of the 6 months, you’ll be unenrolled from our dual plan.
But remember, you can enroll in a dual plan at any time. If you get your Medicaid coverage back, just talk with a UnitedHealthcare licensed sales agent to re-enroll in a dual plan.
Our dual plans typically cover preventive care and routine services at no extra cost to you. We also offer help with coordinating Medicaid benefits. Other standard benefits that are usually covered by our dual plans include:
Please note: What dual-eligible plans you can get depends on where you live. To find a UnitedHealthcare Dual Complete® plan for you, please search plans in your state.
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