What does it mean to be partial dual eligible?

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.

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

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.

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
• And much more

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.

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.