Benefits

Dually Eligible Beneficiaries

All dually eligible beneficiaries receive the standard package of Medicare benefits but they may receive different types of Medicaid benefits. Most receive full Medicaid benefits (72 percent) and are known as full-benefit dually eligible beneficiaries. Others (28 percent) only receive assistance through the Medicare Savings Programs (MSPs), and are known as partial-benefit dually eligible beneficiaries.

Medicaid services offered to full-benefit dually eligible beneficiaries vary by state. States must cover benefits such as inpatient hospital and nursing facility services when Medicare limits on covered days are reached, nursing home care not covered by Medicare, and transportation to medical appointments. With certain exceptions (e.g., for children under age 21), states may place limits on both mandatory and optional benefits by defining medical necessity and the amount, duration, and scope of covered services. States have the option to cover additional benefits, including personal care and a wide range of other home- and community-based services, dental care, vision and hearing services, and supplies.