Understanding dual eligibility: MassHealth and Medicare

On Behalf of | Feb 4, 2025 | elder law

Managing the long-term healthcare of your loved ones can be challenging, especially when dealing with MassHealth and Medicare. Determining dual eligibility can help you get the most from your loved ones’ benefits and ensure they get comprehensive care. 

What Is dual eligibility?

Dual eligibility means your family member qualifies for both MassHealth (Medicaid in Massachusetts) and Medicare. This status lets them benefit from both programs, giving them more coverage for their healthcare needs. Dual-eligible people often have low incomes and few resources, making them eligible for both types of aid. 

Benefits of dual eligibility

When your family is dual eligible, you can use these benefits: 

  • Comprehensive coverage: They get a mix of services covered by MassHealth and Medicare, lowering out-of-pocket costs. 
  • Coordinated care: Programs like One Care combine services to provide smooth care coordination, improving their healthcare experience. 
  • Additional services: MassHealth may cover services that Medicare does not, such as long-term care and specific home and community-based services.  

These benefits can significantly improve your family member’s access to needed medical care and support services. 

How to qualify for dual eligibility

To qualify for dual eligibility, your family member must meet the rules for both MassHealth and Medicare. Here are the main steps: 

  • Medicare eligibility: Usually, they must be 65 or older or have a qualifying disability. 
  • MassHealth eligibility: They must meet income and asset limits set by Massachusetts. 
  • Application process: They must apply for both programs separately, giving the needed papers to prove their eligibility.  

Meeting these criteria ensures your family can access the full benefits for dual-eligible people. 

Maximizing your family’s benefits

Knowing how to handle dual eligibility can help your family get the most benefits. Here are some tips: 

  • Stay informed: Keep up with changes in MassHealth and Medicare policies. 
  • Seek help: Work with a healthcare advisor or lawyer to understand your family’s options and ensure your loved one gets all entitled benefits. 
  • Take advantage of care programs: Use integrated programs like One Care for better care coordination.  

Following these tips ensures your loved ones get as much care and support as possible. 

If you need help understanding dual eligibility and navigating MassHealth and Medicare, consider contacting a lawyer. They can guide you through the process and ensure your loved ones get the benefits they deserve.