Understanding Dual Eligibility: A Guide for People with HIV About Medicare and Medicaid Coverage

Medicare-Medicaid dual eligibility can be a complex topic with many nuances.

This tool is intended to help people with HIV understand the basics of eligibility and coverage, the unique benefits of being dually eligible for both programs, as well as how the Ryan White HIV/AIDS Program (RWHAP) can support dually eligible clients.

This tool covers:

• Medicare and Medicaid eligibility criteria
• Common pathways to dual eligibility
• Important health coverage priorities for dually eligible RWHAP clients, including access to HIV and non-HIV providers, medications, and support services
• Common health coverage considerations for dually eligible RWHAP clients, including:
  • The key elements and importance of care integration and care continuity
  • The order of payors for dually eligible individuals
  • The role of RWHAP and RWHAP Part B ADAP in supporting dually eligible clients with Medicare and Medicaid premiums, cost-sharing, and copays
• Sources of financial help, such as Medicare Savings Programs and the Extra Help program
• How to discuss health coverage and enrollment needs with case managers or HIV providers and get connected to enrollment support