Medicare & Medicaid Coordinated Benefits

What is a Medicare-Medicaid Coordinated Plan?

The Medicare-Medicaid Coordinated Plan is a program created to help manage financial responsibility for Medicare as well as most Medicaid benefits, in addition to providing additional supplemental services. In general, a coordinated plan will make it possible for Medicaid beneficiaries to benefit from having one or more reliable health insurance coverages that fit their overall health care and prescription needs. 

How does it Work? 

Medicare becomes the primary payer for people who are deemed dual-eligible. In addition, Medicaid coverage now picks up the costs that Medicare may not cover, such as deductibles and coinsurance. Medicaid may also cover long-term nursing home expenses, personal in-home care, and other supportive services not covered by Medicare.

Why Coordinated Care?

Coordinated care combines the coverage of Medicare and Medicaid benefits through a single source, in addition to the following provisions, but not limited to: 

  • Ensures claims are paid correctly by identifying the health benefits available to a Medicare beneficiary, coordinating the payment process, and ensuring that the primary payer, whether Medicare or other insurance, pays first.
  • Accommodates all of the coordination needs of the Part D benefit.
  • Determining the correct primary payer - Making sure that pharmacy claims are routed to and paid by each insurer or payer in the proper order.
  • Are You Eligible?

If you are 21 years of age or older, eligible for both Medicare and Medicaid, you are considered dual-eligible. Additionally, if you experience significant health or financial loss and require additional services and support that can help you reach health goals, you might qualify for dual coverage.

Did you know that you may qualify for a plan that integrates your Medicare and Medicaid benefits through a single entity?