Full Definition

Dual-eligible beneficiaries receive Medicare as their primary insurer and Medicaid as their secondary, which may cover Medicare cost-sharing (deductibles, copayments, and coinsurance) and additional services not covered by Medicare. In Texas, most dual-eligible seniors receive their benefits through the STAR+PLUS managed care program, which coordinates Medicare and Medicaid coverage through a single managed care organization.

For post-acute care, dual eligibility is significant: Medicaid can cover long-term SNF care after Medicare SNF benefits are exhausted (day 101 and beyond), making SNF placement much more financially sustainable for dual-eligible patients. For assisted living, STAR+PLUS may cover certain services within the community for enrolled members.

Navigating dual eligibility is complex. Benefits advocates at Area Agencies on Aging and State Health Insurance Assistance Programs (SHIP) can help families understand what both programs cover.