Over 12 million Americans have both Medicare and Medicaid coverage.
These individuals, often called dual eligibles, have several options for coordinating their coverage and care.
Our integrated care toolkit breaks down coverage options in an easy-to-understand format for counselors and consumers.
Over 12 million Americans have both Medicare and Medicaid coverage. These individuals are often referred to as dual eligibles, or duals.
Medicare covers most preventive and primary care services, as well as prescription drugs. Medicaid is responsible for the coverage of long-term services and supports (LTSS), some behavioral health services, and pays for Medicare premiums and cost-sharing.
Dual eligibles can encounter confusion when navigating their choices for coverage. Some beneficiaries may choose to receive their Medicare and Medicaid coverage separately, to allow broader choice over providers. Others may wish to receive their coverage through a single, integrated care plan that can help coordinate services.
Use our integrated care toolkit
NCOA has partnered with the Medicare Rights Center to develop this toolkit for counselors who work with dual eligibles, and beneficiaries themselves. This toolkit was created following interviews and focus groups with counselors, and will be updated and enhanced with additional materials on an ongoing basis.
- This chart walks through the different integrated care plan models
- The accompanying primer reviews the current landscape of integrated care plan models and recent legislative changes to how they are implemented
- Get answers to frequently asked questions in this FAQ
- Need to train staff and volunteers about these issues? Feel free to adapt and use this PowerPoint slide deck
In addition, we have two brief fact sheets that you can share with duals you may be counseling:
- A consumer-friendly overview of integrated care options
- Questions that dual eligibles should ask when weighing what coverage to select
Discover integrated care choices online
The SCAN Foundation created My Care, My Choice to help duals in California discover the integrated care options available to them through an easy-to-use online decision support tool. With support from the U.S. Administration for Community Living (ACL), NCOA is working to expand this tool into additional states, starting with Ohio in late 2021. Visit mycaremychoice.org to explore more.
Dual eligibles and ACOs
If you are counseling clients who opt to receive Original Medicare and not enroll in an integrated care plan, you may still wish to educate them about Accountable Care Organizations (ACOs). ACOs are groups of doctors, hospitals, and other providers that work together to provide care for people in regular Medicare, and are rewarded for providing high-quality care. Learn more about ACOs (information in English and Spanish).