Original Medicare Part A and Part B benefits do not provide coverage for routine dental care, so many recipients need to find solutions to help pay for dental services like checkups, X-rays, and teeth cleanings. Many recipients enroll in a separate insurance policy in order to get those benefits. Medicare recipients in Michigan who qualify may be able to enroll in both Medicare and Medicaid, or a Medicaid-managed program, that provides some dental care benefits.
Medicare-Medicaid Full and Partial Dual Eligibility
Dual eligibility occurs when an individual who receives Medicare also qualifies for Medicaid-related assistance based on low income. Recipients can be classified as full dual-eligibles or partial dual-eligibles. Qualification can affect the benefits and coverage you receive.
Each state has the ability to set the income and asset limits necessary to qualify for assistance, and these limits can change each year. Residents of Michigan should verify the current year’s limits in order to determine which eligibility category they fall under. Additional factors, such as certain disabilities and marital status, can impact eligibility.
Full dual-eligibility means Medicare recipients receive all Medicaid-related benefits. In most cases, recipients who receive medical services will have their copayments, coinsurance and deductible amounts paid for by their needs-based coverage.
Partial dual-eligibility places Medicare recipients into the following categories of Medicare Savings Programs:
- Qualified Medicare Beneficiary (QMB). Applicants must be enrolled in Medicare Part A. Applicants who meet the financial requirements for this program receive help paying for premiums associated with Original Medicare in addition to other out-of-pocket expenses related to Medicare. Certain criteria determined by the state may allow applicants to receive full needs-based assistance under this category.
- Specified Low-Income Medicare Beneficiary (SLMB). Applicants must be enrolled in Medicare Part A. Applicants who meet the financial requirements for this program receive help paying for Part B premiums. Certain criteria determined by the state may allow applicants to receive full needs-based assistance under this category.
- Qualifying Individual (QI). Applicants must be enrolled in Medicare Part A. Applicants who meet the financial requirements for this program receive help paying for Part B premiums. Full needs-based assistance is not available for individuals under this category.
- Qualified Disabled Working Individual (QDWI). Applicants with a qualifying disability who have lost premium-free Part A Medicare benefits due to resuming employment may be eligible for this program, which pays the premium for Part A. Full needs-based assistance is not available for individuals under this category.
Medicaid Dental Coverage Options in Michigan In Michigan, adults who are dual-eligible recipients of both Medicare and Medicaid may qualify for coverage of certain dental services. Full dual-eligibility may grant recipients access to routine dental care and some emergency or restorative procedures with prior authorization.
Recipients who qualify for Medicare Savings Programs that also offer full Medicaid-related benefits coverage may also access some routine dental services and certain extras. Recipients who receive Medicaid-administered help with long-term care services may qualify for dental coverage as part of that program’s package of benefits.
An important fact to keep in mind is that states are not required by federal law to offer dental services as part of their needs-based health care programs for low-income residents. These services are optional, so any state can change the rules that govern coverage, which dental services are included with routine care, and who can qualify for those services based on income, age and other demographic factors.
Additionally, the state’s agency contracts with private insurers to administer benefits and each insurer may have a different process for prior authorization or approval of service, so recipients should contact their provider to confirm which services are covered for their qualifying category.
Related articles: