Roughly 13 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.
Roughly 13 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.
|Chart of integrated care models||Professionals|
|Primer that reviews the current landscape of integrated care plan models and recent legislative changes to how they are implemented||Professionals|
|FAQ about integrated care, Medicare & Medicaid||Professionals,
|PowerPoint training deck||Professionals||PPT|
|Comparison chart of Original Medicare, PACE, & integrated D-SNPs||Professionals,
|Comparison chart of Original Medicare, D-SNPs, & integrated D-SNPs||Professionals,
|Questions to ask when weighing coverage choices||Consumers|
|NEW! Default enrollment into D-SNPs fact sheet||Professionals|
Need a quick overview of the basics of integrated care for people with Medicare and Medicaid? Watch our video tutorial below:
Download this infographic to use as a quick shorthand guide.
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 expanded this tool into Ohio in 2021, and will be adding Michigan in 2022. 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).