Ocala, FL attorneys

Ocala, FL Dual Eligibility

In the United States, there are about 10 million people who qualify for coverage under both the Medicare and Medicaid programs, including low-income seniors and younger people with disabilities. These people are usually among the most disabled, chronically ill and costly in their program. Because of their costly and complex health care needs, these people qualify for both programs, known as dual eligibility. Dual eligible beneficiaries have been the focus of various initiatives in an attempt to raise the quality of their care while reducing the costs, it has been estimated that dual eligible beneficiaries cost about 60-percent more on average than non-dual eligible individuals.

Qualifying for Dual Eligibility in Ocala, FL

Seeking dual eligibility for Medicare and Medicaid can sometimes be complex and time consuming. At McGraw, Rauba & Mutarelli, we can provide you with Social Security disability attorneys in Ocala to help navigate you through the overwhelming process of qualifying for dual eligibility.

What is Medicare?

Medicare is a health insurance for people 65 years of age or older, no matter their income, younger people who are disabled, and any people of any age with End-Stage Renal Disease. The program is attached to Social Security and paid for by people who pay into Social Security. Medicare is a four-part program and is administered by the federal government. The four different parts include:

  • Part A: Coverage for hospital visits, nursing facility visits, and home health care.
  • Part B: Pays for most doctors and laboratory costs, certain outpatient medical services including as supplies and equipment, home health care, and physical therapy.
  • Part C: Supplemental insurance that is privately purchased can provide additional services.
  • Part D: Prescription drug coverage covers some of the costs of prescription medications.

To obtain Medicare coverage, beneficiaries can receive part A and part B services through the original Medicare program, although part D must be a stand-alone prescription drug plan, or through services from a MA plan, which include part D coverage.

What is Medicaid?

Medicaid is an assistance program funded by the Federal and State government. Its goal is to provide medical coverage to individuals and families with low incomes, and sometimes, with limited resources. The program is administered by states and local governments although it follows federal guidelines and the services offered can vary from state to state. The program cover certain “medically necessary” services according to the Federal government and can include:

  • Hospitalization
  • Doctor services
  • Laboratory services
  • X-rays
  • Nursing services and nursing facility services
  • Clinic treatment
  • Screening, diagnosis, and treatment services for people under the age of 21

Dual Eligibility for Medicare & Medicaid

If a person qualifies for both Medicare and Medicaid, he or she can enroll in order for the two to be coordinated to cover health care costs. The Affordable Care Act created the Medicare-Medicaid Coordination Office in order to make the two programs work together in a more effective manner that could improve care for individuals while reducing the costs. Medicare-covered services also covered by Medicaid are first covered by Medicare because it is generally the payer of last resort. Medicaid may either fully or partially cover the costs of care that Medicare does not. In order to meet dual eligibility, a person must meet certain income and resource standards defined by Federal law, but they can be effectively raised at the discretion of the states. Because of this, may people often find it complicated to qualify for dual eligibility when they need it. At McGraw, Rauba & Mutarelli, our disability attorney in Ocala can help you navigate all of your Social Security claims.

Disability Attorney in Ocala, FL, for Dual Eligibility

At McGraw, Rauba & Mutarelli, we know that there are many guidelines and rules in order to qualify for dual eligibility that can be confusing. That is why we help our clients with filings and guide them through the whole process so they have a higher chance of being approved, while reducing the risk of setbacks. We know the importance of dual eligibility for those people who need it most and we strive to provide solid guidance in order for them to obtain it. Contact us today for Ocala attorneys you can rely on.


(352) 789-6520