What is Dual Complete? 

Dual Complete is a subsidized program under Medicare Advantage plans and requires you to have both Medicare and Medicaid.

  • To qualify for Medicare, you must be 65 years old or have a permanent disability for more than 2 years. 
  • To qualify for Medicaid, you must meet your state’s income limits. 

(Below I provide approximate qualifications for Washington State.)

When you have or qualify for Medicare and Medicaid, you are now “dual qualified.” 


How payments work when dual qualified

For Dual qualified individuals. The federal government pays 80% of your Medicare bills on outpatient procedures and Medicaid picks up the additional 20%, co-pays, and deductibles.

When you are on any Medicare Advantage plan, your insurance company covers 80% of the bill and the government reimburses the insurance company through a subsidy check every month you are on the plan, and you remain legally entitled to all benefits Medicare covers.

Medicaid beneficiaries with full coverage get 80% covered, then Medicaid picks up your Medicare Part B premium, Dual Complete premium, and your 20% co-pays and deductibles. 

This is why you end up paying nothing for your healthcare.


Medicaid cover qualifications in WA

  • To receive full Medicaid in Washington State, you must have an income under $950.00 per month. (You can have no more than $2000.00 in the bank or other cash assets.) 
  • To receive partial Medicaid, your income needs to be under $1500.00 per month, and you can have no more than $2000.00 in the bank or other cash assets. 

You are responsible for your 20%, co-pays, and deductibles, often referred to as a “spenddown,” that includes co-pays and deductibles, but your Part B premium will be covered.

For the complete list of rules, visit Washington State Department of Social and Health Services.


Do I need a dual complete plan if everything is covered?

Advantage Plans provide extra benefits typically not covered by Medicare or Medicaid.

  • Most Dual Complete plans offer added or increased coverage for dental, vision, transportation, chiropractor, gym membership, food credit cards, emergency response buttons, and more. 
  • Some Dual Complete plans cover 100% of your prescription medicine cost.


Why am I paying a premium when I have Medicaid?

With full Medicaid, everything is covered. If you are considered partial coverage, you can be billed for your Dual Plan premium – that 20% “spenddown” mentioned above. 

In Washington State, it can also depend on your county of residence. 


This can be very confusing

When seeking healthcare coverage through a Medicare Advantage Plan, you are required to utilize the insurance company’s network and, depending on where you are in the state, this can be a major decision. 

In Washington, there are major networks from Centralia to Everett, and most large carriers offering the Dual Complete plans are in the majority of networks.

With a good local agent, you have an invaluable resource to help you manage and understand your benefits. 


This is where Johnson Medicare Solutions can help

We have been in business for more than 18 years and I have worked the I-5 corridor this whole time. We know who takes what plans. 

We work with Medicare 12 months a year. We have staff always able to take your calls and return your emails. We have helped countless individuals who have spent hours on the phone with “Corporate America” or because their agent does not call them back.

An added major benefit we can provide with a few select carriers is an assigned individual—referred to as “navigators”— behind the scenes helping you manage your healthcare. 


Keeping in touch

Johnson Medicare Solutions values their relationship with our clients. Throughout the year, we reach out and call you to stay in touch and see that your needs are being met. We are available including offering home appointments at any time to keep you on track.


We are here for you

I hope this helps answer some of the questions you might have. Feel free to email us, call us, or attend our free local seminars where you can have your questions answered. 

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