Medicare/Medicaid Dual Eligible Demystified

Qualifying for Medicare & Medicaid


If you are 65 or older with limited financial resources or under 65 and qualify for disability and enrolled in Medicare you may qualify for Medicaid or a Low-Income Subsidy to pay for medical treatment and prescription drugs. The Buckley Agency has 18 different plans from 6 different insurance companies specializing in Medicare Supplement or Medicare Advantage Dual Needs Plans you may enroll in. If you need help enrolling in Medicare contact us and we can help because we specialize in Dual Eligibility.

Insurance companies we represent include Aetna, Humana, Clover, Wellcare and UnitedHealthcare®. 

Contact us so we can look up your Medicare & Social Security # and confirm your eligibility.

Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources. Medicaid offers benefits not normally covered by Medicare, like nursing home care and personal care services. The rules around who’s eligible for Medicaid are different in each state.
Qualifying for Medicaid

Generally, you must meet your state’s rules for your income and resources, and other rules (like being a resident of the state).

You might be able to get Medicaid if you meet your state’s resource limit, but your income is too high to qualify. Some states let you “spend down” the amount of your income that’s above the state’s Medicaid limit. Other states have a "look back" period which means they You literally look back at what your financial records (Bank statements, tax returns, etc) You do this by paying non-covered medical expenses and cost sharing (like premiums and deductibles) until your income is lowered to a level that qualifies you for Medicaid. To get more details, call your State Medical Assistance (Medicaid) office and ask about medical help for people with limited resources and ask about medical help for people with limited resources. 

Depending on the level of Medicaid you qualify for, your state might pay for: Medicare premiums, deductibles, coinsurance, and copayments.

If you have Medicare and qualify for Medicaid coverage or your state's Low-Income Subsidy your state will pay your:

  • Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage.
  • Medicare Part B Medical Insurance monthly premiums.
  • Part D (Prescription Drug Costs)
    You'll automatically get Extra Help 
    with your drug costs. Learn more about Extra Help.

Medicaid may also pay for other drugs and services that Medicare doesn't cover. 

People who have both Medicare and full Medicaid coverage are “dually eligible.” Medicare pays first when you’re a dual eligible and you get Medicare-covered services. Medicaid pays last, after Medicare and any other health insurance you have.

You can still pick how you want to get your Medicare coverage: 

Medicare plans are available as:

  • Original or Traditional Medicare (Parts A & B)
  • Medicare Advantage Plans (Part C)

If you choose to join a Medicare Advantage Plan, there are special plans for dual eligibles that make it easier for you to get the services you need. 

To apply for Medicaid: Contact your State Medical Assistance (Medicaid) office or Social Services Office in the County in which you live.

Contact Us at the Buckley Agency for help making selections and remember:

At the Buckley Agency: Insurance is Demystified!

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