The Medicare Savings Program is jointly funded by the State of Washington and the Federal Government, and is administered through DSHS.  Although it's collectively referred to as a Medicaid program, it operates with rules specific to those on Medicare and is different from "Apple Health."   If someone is eligible for Medicaid or the Medicare Savings program, we will refer to them as DUAL ELIGIBLE.

There are basically two types of eligibility. Those that are FULL Dual and those that are PARTIAL Dual.  The primary differences in qualifications are largely based on household income and assets.  In some cases, exceptions are made for certain medical conditions and level of need.

Full Dual individuals will have all of their Part B premiums paid for, along with all associated Part B and Part A co-pays, co-insurance, and deductibles.  They may still be obligated to pay costs for services not covered by Medicare.   The generally qualify for additional Medicaid benefits, even if some are required to pay a small spend-down before receiving those additional benefits.

All Full Dual individuals qualify for an additional Medicare Advantage plan that gives them even more benefits, while retaining all their original benefits associated with being Full Dual.  Additional benefits that are otherwise not include with Original Medicare may include some of the following (these are enhanced benefits in addition to any benefits included with Medicaid):

• Enhanced priority Transportation assistance
• Food benefits
• Gym membership
• Dental coverage
• Vision coverage and eye wear allowance
• Over the Counter medical supply allowance (which may include product catalogs and/or select in-store purchases)
• Hearing aid allowance
• Routine Podiatry
• Routine chiropractic and acupuncture care
• Nurse line
• and more

These are Dual Special Needs Plans (DSNP) specifically designed for them.  It would be illegal for us to knowingly offer a Medicare Supplement plan to anyone who is Full Dual, but a DSNP plan is highly encouraged.   Please contact us for details, availability, and qualifications.  Some restrictions apply.

Partial Dual individuals are those that only qualify to have their Part B premiums paid for.  They are still obligated to pay for their co-pays, co-insurance, deductibles, and other associated costs not covered.  Some individuals who qualify for Partial Dual eligibility might be told they have a spend down.  That simply becomes their Out-of-Pocket Maximum.  Once they hit their spend down (often prohibitively high), their Medicaid pays the remainder of their medical expenses.  We will generally recommend a quality Medicare Advantage Plan to help reduce short term costs, to supply prescription drug coverage, and to sometimes add additional valuable benefits.  We have several options available for those who may only be "Partial Dual Eligible," which can greatly increase benefits and assist in reducing many of the costs related to healthcare.

For FREE guidance on qualifications or assistance with applying for the Medicare Savings Program with DSHS, please contact us for details.  I have met many individuals and couples who were told they make too much for Medicaid (Full Dual) but DID in fact qualify for the Medicare Savings program (Partial Dual).  Some of these people failed to enroll in the program that would have paid their Part B premiums and provided discounts for additional coverage.  Don't let that happen to you.  We can help with a free review.