Integrated Care for Dually Eligible Beneficiaries
Medicare – Medicaid Integration
Medicare and Medicaid integration has been an ongoing collaborative effort of the Department of Social and Health Services and the Heath Care Authority with the aim to improve access to and participation in integrated care and services in Washington for the dual eligible population (clients on Medicare and Medicaid) through making strategic improvements to the Medicare Advantage integrated Dual Eligible Special Needs Plan (MA DSNP) program. The goal is sustainable and meaningful transformation in care delivery for the dually eligible population that addresses the whole person through robust care coordination to ensure physical, behavioral and social health needs are being met. DSNPs are also the only Medicare Advantage Plan that have both State and Federal regulatory oversight.
What is Medicare
Medicare is a federal health insurance program for people aged 65 or older or under age 65 with certain disabilities. Click her for more detailed Information on Medicare.
Two ways to get your Medicare healthcare coverage
All Medicare beneficiaries have a choice between two options on how they receive their Medicare:
1. Original Medicare is directly through the federal Medicare agency and enrollment into Medicare is done through the click the Social Security Administration (SSA). Click here for more information on Enrollment into Medicare.
Once enrolled in Original Medicare, you have the option to stay with Original Medicare or you can opt to get your Medicare through a Medicare Advantage Plan.
2. Medicare Advantage plans are available through private healthcare plans contracted with the federal government to administer Medicare through a managed Medicare Advantage plan. Medicare Advantage plans cover all benefits that Original Medicare cover in addition to offering supplemental benefits not covered by Original Medicare. To explore Medicare Advantage Plan options available in your area, you can use the Medicare Plan Finder.
Help Enrolling into Original Medicare or Medicare Advantage
Statewide Health Insurance Benefits Advisors (SHIBA) is a free, unbiased service that provides help with all things Medicare. Contact SHIBA at 1-800-562-6900 or online https://www.insurance.wa.gov/find-local-shiba-office.
Dual Eligible Special Needs Plans (DSNPs)
DSNPs are a subset of Medicare Advantage plans sold by private insurance companies and enroll individuals who are entitled to both Medicare and Medicaid and encompass all categories of Medicaid eligibility. In Washington State, DSNPs are known as Apple Health Medicare Connect (D-SNP). DSNPs offer everything Original Medicare offers and include supplemental benefits and services not covered by Original Medicare. DSNP supplemental benefits are more robust than those of standard Medicare Advantage plans. DSNP Enrollment Information
Dually eligible beneficiaries enrolled in an Apple Health Medicare Connect DSNP will have a Medicare Advantage DSNP card and an Apple Health card in addition to their ProviderOne Services card to take to their medical appointments.
Medicare Savings Programs
How can the Medicare Savings Programs (MSP) help Medicare beneficiaries?
MSP is a federal and state program that helps people with limited income pay the costs associated with their federal Medicare health insurance. To qualify for the MSP, you must be eligible for Medicare and meet the MSP income eligibility requirement. If a client qualifies, the MSP can help pay their Medicare Part B premium, deductible, coinsurance and copayments, depending on MSP level. Apply for Medicare Savings Program (MSP) https://www.washingtonconnection.org/
What does it mean to be Full Dual or Partial Dual
Dually eligible individuals meet the eligibility requirements for both Medicare and Medicaid.
Full, dually eligible beneficiaries have Medicare coverage and in addition are eligible for full Medicaid benefits. Partial dually eligible beneficiaries do not meet the income eligibility requirements for Medicaid but, may still qualify for some assistance in paying their Medicare Part B premium through a Medicare Savings Program (MSP).
Understanding Medicare Starts Here
NEW Medicare 101 Series: Medicare in 15 Minutes Medicare 101 Series: Medicare in 15 Minutes, offers monthly 15-minute high-level overview on all things Medicare and dual eligibility (individuals eligible for both Medicare and Medicaid).
Register in advance: https://dshs-telehealth.zoom.us/webinar/register/WN__o4wbQt1SPOF32Jfx8W9nA
Training Information
- Medicare 101 Training
- Medicare In 15 Minutes
Resources
Client Resources
- HCA Apple Health Medicare Connect Client Resources
- Medicare & You Handbook
- Medicare Enrollment Periods & Related Forms
- Statewide Health Insurance Benefits Advisors (SHIBA)
- Washington Connections your link to services
Stakeholder Resources
- HCA Apple Health Medicare Connect Stakeholder Resources
- LTC & MA Plan Coordination resource document
- CMS What You Should Know About DSNPs
Provider resources
Resources for Advocates
- Justice in Aging: Important Changes in 2025 to Special Enrollment Periods for Low-Income Medicare Enrollees
- NCLER Training: Legal Basics: Medicare Parts A, B, and C (Recording & Issue Brief)
- NCLER Chapter Summary: Medicare Savings Programs
- NCLER Practice Tip: Your Low-Income Clients May be Overpaying for Part D Prescription Drug Coverage
- Justice in Aging: Important Update: Medicare Enrollees Could Lose Financial Assistance for Drug Costs if They Do Not Act
Centers for Medicare and Medicaid Services: Medicare Open Enrollment (includes outreach materials)
Frequently Asked Questions