![]() ![]() MSPs cover costs such as Part A premiums and Part A and B deductibles, coinsurance, and copayments, depending on the program. Dual-Eligible Beneficiariesĭual-eligible beneficiaries (or “duals”) are enrolled in Medicare Part A and/or Part B, and in Medicaid (full benefits) and/or in Medicare Savings Programs (MSPs). Part C – Medicare Advantage Plan (offered privately)Īll dual-eligible beneficiaries qualify for full Medicare benefits, but the level of benefits for which they are eligible under Medicaid can vary, generally depending on the beneficiary’s income and asset levels.Part B – Medical insurance (physician services, lab and x-ray services, outpatient and other services).Part A – Hospital insurance and associated costs.There are four parts of Medicare coverage: Context MedicareĪn individual is eligible for Medicare if he or she is 65 or older, younger than 65 with disabilities, or has end-stage renal disease. Medicaid covers services that Medicare does not cover, and these benefits are outlined in detail in this guidance. The two programs cover many of the same services, but Medicare pays first for the Medicare-covered services that are also covered by Medicaid. ![]() Background Discussionĭual-eligible beneficiaries are individuals who receive both Medicare and Medicaid benefits. This guidance explains how states are expected to report dual-eligible beneficiaries in the T-MSIS Eligible File. This guidance replaces the original Dual Eligible guidance from October 6, 2016.
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