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Frequently asked questions for people with Medicaid and Medicare

Most commonly asked

UnitedHealthcare health plans are offered by United Healthcare Insurance Company and our affiliates. 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. Learn more about Medicare

Dual Special Needs Plans (also called dual health plans or D-SNPs 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.1 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:

  • Are designed for people who may need extra help because of disabilities, age and/or health conditions
  • Provide more benefits than Original Medicare1
  • Are offered by private insurance companies like UnitedHealthcare
  • Come with no additional costs

1Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply.

(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.) Learn more about Dual Special Needs Plans.

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

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.

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. Learn more about Medicare. 

Medicaid is a federal and state program that provides health care coverage to people who qualify. Each state runs its own Medicaid program, but the federal government has rules that all states must follow. The federal government also provides at least half of the funding for their Medicaid requirements. Learn more about what Medicaid is and what Medicaid covers.

No. Referrals are not needed to get care from any in-network doctors, hospitals or clinics.

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:

  • Dental
  • Vision
  • Hearing
  • Transportation assistance
  • Nursing hotline]
  • And many other benefits and features1

1Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply.

Members in Dual Special Needs Plans (D-SNPs) can join, switch or drop their plan 1 time during each 3-month enrollment period. These periods are January to March; April to June; and July to September.

If you make a change, it will take effect on the first day of the next month. You can also make changes to your coverage during the Annual Enrollment Period from Oct. 15 to Dec. 7. If so, your changes will take effect on Jan. 1 of the next year. Learn more about Medicare enrollment periods.

Coordination of benefits (COB) applies to people who have coverage under more than one health plan. COB refers to which plan is the primary (first) payer and which plan is the secondary payer. The primary payer coordinates the delivery of all health plan benefits. The secondary payer covers what the primary payer doesn’t cover on costs and benefits.

Dual Special Needs Plans (D-SNPs) are a type of Medicare Advantage plan. As such, the D-SNP coordinates the delivery of both the Medicare and Medicaid benefits. In most cases, Medicaid covers benefits and costs the D-SNP doesn’t cover. D-SNPs also coordinate care management, disease management and other clinical services.

UnitedHealthcare Community Plan serves members who qualify for Medicaid or for both Medicaid and Medicare in 42 states and the District of Columbia.*

UnitedHealthcare offers Medicaid plans in these states:
Arizona, California, Florida, Hawaii, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maryland, Michigan, Minnesota, Missouri, Mississippi, North Carolina, Nebraska, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Virginia, Washington, Wisconsin

UnitedHealthcare offers Dual Special Needs Plans (D-SNPs) in these states**:
Alabama, Arkansas, Arizona, California, Connecticut, Colorado, District of Columbia, Delaware, Florida, Georgia, Hawaii, Iowa, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maryland, Maine, Michigan, Missouri, Mississippi, Montana, North Carolina, Nebraska, New Jersey, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, West Virginia, Wyoming

*As of February 2022
**Not available in all counties

Our online search directory makes it easy to find network doctors, specialists and care facilities near you. Just enter your ZIP code. Then you can search by doctor name, type of care, facility, services, and treatments to find exactly what you need.

Medicaid Basics

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.

Each state manages its own Medicaid program so what’s covered by Medicaid can change from state to state. But there are some services that every state must cover in their Medicaid program by federal law. These are called mandatory benefits. States can also choose to offer other benefits under Medicaid. These are called optional benefits.

Mandatory Medicaid benefits include:

  • Inpatient hospital care
  • Inpatient short-term skilled nursing or rehabilitation facility care
  • Doctor services
  • Outpatient hospital or clinic care
  • Laboratory and X-ray services
  • Short-term home health care (provided by a home health care agency)
  • Ambulance service
  • Prescription drugs for people not covered by Medicare

Optional benefits offered by some states may include:

  • Eye exams and glasses
  • Hearing tests and hearing aids
  • Dental care
  • Preventive screenings
  • Physical therapy (beyond what is offered under Medicare)
  • Non-emergency transportation to and from medical treatment
  • Some prescription drugs not covered by Medicare
  • Some nonprescription drugs, including certain vitamins
  • Chiropractic care

In most cases, Medicaid pays the full cost for covered services, so people with Medicaid do not have to pay a monthly premium or any deductibles. But there are some exceptions and rules vary by state. In certain cases, if someone has Social Security benefits, a small amount may be taken from those benefits to help cover the cost of Medicaid coverage.

In most cases, Medicaid is the payer of last resort. That means that Medicaid will pay after any other payer has paid its share of the services provided. For example, if you have Medicare or any type of private health care coverage, Medicaid will always be the secondary payer. Health care providers will bill the primary payer first, and Medicaid will pay what’s left over. That’s why Medicaid enrollees must say if they have other sources of coverage.

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:

Personal information

  • Information about household members (name, date of birth and Social Security number)
  • Proof of citizenship

Financial information

  • Rent or mortgage information
  • Expenses (utilities, daycare, etc.)
  • Vehicle information
  • Bank statements
  • Income (pay stubs)

Medical information

  • Proof of disability or medical records showing a lasting medical condition
  • Recent medical bills

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.

Yes. Since D-SNP is a Medicare Advantage plan, Medicare covers most of the costs when Medicare members get medical care. The part or share that’s left over is the member’s responsibility to pay. This may be known as a premium, copay, coinsurance or deductible. For people who are on a D-SNP plan, state Medicaid programs help pay these costs.  

Yes, as long as you meet the qualifications for Medicaid in your state. Whether or not you get Social Security Disability Insurance (SSDI) doesn’t change your Medicaid eligibility. Getting SSDI automatically qualifies you for Medicare, but there’s a waiting period. You’ll likely need to wait 2 years after you qualify for the Social Security disability benefit before you can get Medicare. Learn more about Social Security disability and Medicaid and Medicare.

The Medicaid program in each state is run by the state government for that state. While certain states may offer different types of Medicaid plans, each plan is typically for a certain type of person (such as children, families or low-income adults). It’s not likely you can change your Medicaid plan or switch to a different Medicaid plan unless your life situation changes. (If you get married or become pregnant, for example). You can apply for Medicaid at any time throughout the year. Learn more about Medicaid plans and Medicaid coverage.

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. 

Medicaid + Medicare

Medicaid provides health coverage to millions of people, 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. Learn more about the difference between Medicaid and Medicare

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." Learn more about having both Medicare and Medicaid.

Medicare and Medicaid are two separate programs that have different eligibility requirements.

To qualify for Medicare, you need to be:

  • At least 65 years old, or you’re under 65 and qualify on the basis of disability or other special situations
    AND
  • A U.S. citizen or a legal resident who has lived in the U.S. for at least 5 years in a row

To qualify for state Medicaid benefits, you need to be:

  • 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
  • At least 65 years old and you also:
    • Receive Extra Help or assistance from your state
    • Are blind or have a disability, but do not need long-term care

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.

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.

The Medicare Open Enrollment Period (OEP) runs from Oct. 15 to Dec. 7 every year. Anyone who already has Medicare coverage of any kind can make changes to their coverage for the upcoming year. Medicare Advantage Open Enrollment runs from Jan. 1 to March 31 every year. Only people who already have a Medicare Advantage plan can change during this time. Dual Special Needs Plans (D-SNPs) are a type of Medicare Advantage plan so the same enrollment periods apply. You can apply for Medicaid at any time throughout the year. There are no enrollment periods for Medicaid or CHIP (the Children’s Health Insurance Program). Learn more about Medicare enrollment periods.

Dual Special Needs Plans (D-SNPs)/dual eligibility

"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."

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 with as low as a $0 plan premium. UnitedHealthcare dual health plans include a wide range of extra benefits and features.1

Our plans may cover:

  • Routine dental care
  • Credits to buy OTC products and covered groceries
  • Eye exams, plus credit for eyewear
  • Hearing exams, plus credit for hearing devices
  • And more

1Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply.

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. Learn more about dual health plan benefits

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

1. Do you get state Medicaid benefits? (If so, you’ll have a state Medicaid card.)

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.

  • You are at least 65 years old and you also:
  • Receive Extra Help or assistance from your state
  • Are blind or have a disability, but do not need long-term care

2. Do you have Medicare Parts A and B?

  • You’re at least 65 years old, or you’re under 65 and qualify on the basis of disability or other special situations
    AND
  • You're a U.S. citizen or a legal resident who has lived in the U.S. for at least 5 years in a row

3. Do you live in an area where dual plans are available?

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.

Dual Special Needs Plans (D-SNPs) have an ongoing Special Enrollment Period (SEP), which runs for the first 9 months of the year. People who qualify can enroll or change plans once every 3 months. 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. Learn more about dual plan enrollment

Dual Special Needs Plan (D-SNP) members must be eligible for Medicaid.  If a member loses their Medicaid eligibility, they go into a grace period. Depending on the health plan, this grace period could be 30 days or up to 6 months. Members can still get care and services through their health plan, and Medicare will still pay for most of the care and benefits covered. The only difference is that, during the grace period, the D-SNP member will be responsible for any out-of-pocket costs. These could be copayments, coinsurance, deductibles and premiums that Medicaid would have paid for before. Learn more about losing D-SNP eligibility.

D-SNP stands for Dual Special Needs Plan. These plans are for low-income individuals who are dually eligible for both Medicaid and Medicare. C-SNP stands for Chronic Special Needs Plan. These plans are for people who have a chronic health condition. Examples include chronic heart failure, cardiovascular disorders and diabetes. Learn more about Medicare Special Needs Plans.

Medicare Part D is prescription drug coverage. It covers certain prescription drugs that aren’t already covered by Medicare Parts A and B. Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage plan. Dual health plans include drug coverage. But if you take any prescription medicines, you’ll want to make sure your drugs are covered by a dual health plan before you enroll. Learn more about dual health plan prescription drug coverage.

If you have a Dual Special Needs Plan (D-SNP), it’s likely that most of your costs will be covered for you. When Medicare members get medical care, Medicare doesn’t cover the full amount of the services. The part or share that’s left over is the Medicare member’s responsibility to pay. This may be known as a premium, copay, coinsurance or deductible. State Medicaid programs help pay these costs for low-income individuals. If you don’t have Medicaid, your exact costs may depend on the plan you choose.

Yes, Dual Special Needs Plans (D-SNPs) are network-based. These plans require members to get care and services from doctors or hospitals in their Medicare SNP network. SNP networks vary in size and the populations they serve. Types of networks include:

  1. Networks covering a specified area. For example, one network may cover an entire state, while another network covers one county. Often, this means that an area might be served by more than one network.
  2. Networks dealing with a certain health issue, such as dementia. Providers who provide services to patients with the specified condition can join the network.

Learn more about finding the right doctor when you have Medicaid and Medicare.

Both Dual Special Needs Plans (D-SNPs) and Medicare-Medicaid Plans (MMPs) are designed to make it easier for dual-eligible individuals to get care. These plans streamline access to care through Medicare and Medicaid. But there’s a key difference. With an MMP, all Medicare and Medicaid benefits are provided through 1 single health plan. With a D-SNP, members keep the same Medicaid plan and all the same Medicaid benefits as they get today. Plus, they have a separate Medicare Advantage plan that typically gives them more benefits and features than with Original Medicare. Another difference is that only people who are full dual eligible can enroll in an MMP, whereas it’s possible for both full and partial dual eligibles to get a D-SNP. Learn more about Medicaid benefits with D-SNPs.

Yes. Dental coverage* is one of the many extra benefits you could get at no cost with a Dual Special Needs Plan (D-SNP) from UnitedHealthcare. Besides regular exams and cleanings, you may also get an allowance for dental services. This allowance could help pay for range of dental care, such as fillings, root canals, implants and other dental services. Learn more about D-SNP dental coverage for those with Medicaid and Medicare.

*Benefits vary by plan and service area. Limitations and exclusions apply.

Yes. Transportation assistance* is one of the many extra benefits you could get at no cost with a Dual Special Needs Plan (D-SNP) from UnitedHealthcare. You’ll have a set number of one-way rides you can use to take care of health care needs. If you needed to go to a provider visit or to the pharmacy to pick up prescriptions, you could get a no-cost ride to take you there and back. Learn more about D-SNP transportation assistance for those with Medicaid and Medicare.

*Benefits vary by plan and service area. Limitations and exclusions apply.

Yes. Vision coverage* is one of the many extra benefits you could get at no cost with a Dual Special Needs Plan (D-SNP) from UnitedHealthcare. Besides routine eye exams, your vision coverage may also give you hundreds of dollars in credits to help pay for eyewear. That could go a long way toward helping pay for a new pair of glasses or contact lenses. Learn more about D-SNP vision coverage for those with Medicaid and Medicare.

*Benefits vary by plan and service area. Limitations and exclusions apply.

Yes. Enrollment for Dual Special Needs Plans (D-SNPs) is state-based. D-SNPs are offered in most states, but not all states. Also, the types of D-SNPs available (and the benefits each plan provides) can change depending on the county where you live. You can use the search field at the bottom of the page to see what plans are available in your area. If you’re not sure, give us a call and talk with one of our licensed agents. They’ll explain all the choices and help you find the right dual-eligible health plan for you.

See UnitedHealthcare plans in your area

Dual-eligible or Medicaid plan benefits can change depending on where you live. Search using your ZIP code to find the best plan to meet your health care needs.

Still have questions

We’re here to help

Contact us at:
1-844-812-5967 / TTY: 711
8 a.m. to 8 p.m. local time, 7 days a week.

Still have questions

We’re here to help

Contact us at:
1-844-812-5967 / TTY: 711
8 a.m. to 8 p.m. local time, 7 days a week.