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What does it mean to be partial dual eligible?

Posted: August 27, 2022

Last updated date: October 14, 2022

People who qualify for both Medicare and Medicaid are known as dual eligibles. That’s because they’re dually eligible for both programs. But there’s more to it than that. Some people are full dual eligible. That means they qualify for full state Medicaid benefits, including covered medical care. But others are only partial dual eligible. That’s because even though they don’t qualify for medical benefits through their state Medicaid program, they still qualify for some help.

Read on to find out what health plan choices may be available to you if you’re partial dual eligible.

Get your free dual plan guide

 Everything you need to know about Dual Special Needs Plans in one, convenient guide.

There are different levels of partial dual eligibility

There 4 different kinds of partial dual eligibility. Each level also has its own Medicare Savings Program (MSP). The main differences between the types of MSPs are based on:

  1. Financial qualifying limits (how much you earn or own), and
  2. Whether the MSP covers:
    • Copays, deductibles and coinsurance for both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), or
    • Medicare Part B premiums only
    • Medicare Part A premiums only

Some people earn or own too much to qualify for a Medicare Savings Program. Even so, a dual-eligible health plan that’s suited for people who are partial dual eligible may still be a good choice1

Do you have a copay when you see a doctor?

It can take a bite out of your pocket if you have to pay a copay every time you visit the doctor. And if you need to see a specialist, the cost could be even higher. Knowing this, UnitedHealthcare lets people who are partial dual eligible enroll in certain Dual Special Needs Plans (D-SNPs). The advantage is that, with a D-SNP, partial dual members may have lower copays for visits to doctors and specialists.

If you have a typical Medicare Advantage plan now, you may find it pays to switch to a Dual Special Needs Plan

Partial dual members could enjoy more benefits with D-SNP

Members of UnitedHealthcare D-SNPs get many extra benefits at no cost to them.2 These extra benefits could include:

  • A monthly credit to spend on healthy food, OTC products and utility bills
  • $0 copay on all covered generic and brand-name prescriptions
  • Dental coverage, plus credits to help pay for dental services
  • Vision coverage, plus an allowance for eyewear
  • No-cost rides to take care of health needs
  • And much more

The first step is to check plan eligibility requirements

Some Dual Special Needs Plans allow partial dual eligibles to enroll. But other D-SNPs only accept members who are full dual eligible. And it’s not always easy to tell. That’s why your first step should be to check the eligibility requirements for any plan you’re interested in before you start the enrollment process. Also, many UnitedHealthcare D-SNPs that accept partial dual eligibles have the word “Select” as part of the plan name. If not, chances are the plan is only for full dual eligible members.

Get help to find a dual eligible health

Do you think you, a family member or someone you’re a caregiver for qualifies as a full or partial dual eligible? You can use the search field below 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.

Call 1-844-812-5967, TTY: 711
8 a.m. - 8 p.m. local time, 7 days a week. Se habla español.

1 Dual Special Needs Plans with partial dual eligibility categories are not available in all areas.
2 Benefits vary by plan and service area. Limitations and exclusions apply.

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.