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Have Medicare & Medicaid? Let’s Simplify

When you have both Medicare and Medicaid you may be entitled to a Dual Eligible Special Needs Plan.

Dual Eligible Special Needs Plans can offer additional comprehensive coverage that goes above and beyond just Medicare alone such as Care Coordination, Dental Coverage, and Transportation, as well as Extra Help Benefits.

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A Few Benefits of Extra Help

Extra Help amount and benefits depend on income and resources. Most beneficiaries can receive either a full-subsidy or a partial-subsidy that include

No Premiums

No Deductibles

(unless receiving the partial subsidy)

Lowered Prescription Drugs Costs

As Low as $3.60 for Generic and No More Than $8.95 in 2020 for Prescription Drugs

Care Coordination

Vision & Hearing Benefits

Over-the-counter (OVTC) Quarterly Benefits

Transportation Benefits

Wellness Programs

Covering Gym Memberships, SilverSneakers®, Fitness Programs or Acupuncture

Covers Hospital Services

Do you qualify for Extra Help?

Both Medicaid and Medicare (dual eligible) people are often automatically eligible for Extra Help assistance. Others who automatically qualify also include those receiving Medicare Savings Programs and Supplemental Security Income (SSI).

Anyone not enrolled in any of the above programs can still receive Extra Help benefits if they meet the income and assets requirements for 2020 eligibility. For individuals, this means that your annual income is less than $18,735 and your assets are less than $14,390. For married couples, this means that your annual income is less than $25,365, and your assets are less than $28,720.

*Even though these individuals automatically qualify for Extra Help programs, it is still a best practice to seek consultation from benefits counselors to examine all the benefits of a dual eligible special needs plan. 

Beneficiaries that receive Extra Help can also get the following protections:

  • A quarterly Special Enrollment Period (one time every three months between January – September + once during Annual Open Enrollment) to join or switch Medicare Part D drug plans during the year. These opportunities allow people who get Extra Help to not wait for the Annual Open Enrollment Period (Oct. 15 – Dec. 7) to change plans. Any plan changes made outside the Annual Open Enrollment Period will become valid for the following month. This is especially helpful to seniors/adults with disabilities who may need to begin medications that are not on their current plan’s formulary (approved drug list).
  • No Part D late enrollment penalty, even if the beneficiary enrolls late. Meaning protections extend to after they were first eligible to join a Part D plan and if they did not have other drug coverage.

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© Copyright - Simplified Advantage Plans (non-government entity)

This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments and restrictions may apply. Benefits, premiums and/or copayments or coinsurance may change on January 1 of each year.

simplifiedadvantageplans.com is a website owned and operated by Highland Health Direct, LLC dba American Retirement Benefits. Highland Health Direct, LLC is a licensed representative of a Medicare Advantage [HMO, PPO and PFFS] organization and a stand-alone prescription drug plan with a Medicare contract. Highland Health Direct is a licensed representative of a Medicare Supplement Plan. Enrollment in any plan depends on contract renewal.

Not all benefits listed may be available on all plans or in a single plan benefits package. Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (24 hours a day/ 7 days a week) to get information on all of your options. simplifiedadvantageplans.com is not connected or endorsed by the US government or federal Medicare Program. The centers for Medicare and Medicaid (CMS) has neither reviewed nor endorsed this information. We do not offer every plan available in your area. Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

Not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Simplified Advantage Plans is a website owned and operated by Highland Health Direct LLC dba American Retirement Benefits. Highland Health Direct LLC is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations they represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult Medicare.gov

ENROLLMENT IN THE DESCRIBED PLAN TYPE MAY BE LIMITED TO CERTAIN TIMES OF THE YEAR UNLESS YOU QUALIFY FOR A SPECIAL ENROLLMENT PERIOD.

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Last Updated: September 6, 2023
888-410-4987 TTY: 711

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888-410-4987 TTY: 711

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