WI residents could be missing out on dual-plan health benefits

Fall open enrollment starts Wednesday for Wisconsinites who are dual eligible for both Medicaid and Medicare, and experts said nationwide, nearly half of people who qualify are not enrolled.

Data show more than 170,000 Wisconsinites could be eligible for Dual Eligible Special Needs Plans because of age, disabilities or income. The Medicare Advantage Plans can include extra benefits for qualifying conditions such as dental care, health care supplies and even meals and transportation.

Hannah Diamond, senior policy advocate for the advocacy group Justice in Aging, said the aim is to address confusion and barriers to care but stressed the plans are subject to provider networks.

“Their purpose is to improve integration and coordination of Medicare and Medicaid to programs that, when they initially came about, were never designed to work together,” Diamond explained.

Enrollment is open from tomorrow through Dec. 7. Benefits vary by carrier and recent changes to some Medicare Advantage plans in Wisconsin could affect enrollees. People can learn more at getdual.com.

Despite people knowing little about dual plans, nationwide plan enrollment has doubled since 2020 and experts expect it will continue to rise.

Marian Cabanillas, Community and State CEO for UnitedHealthcare, said under new federal guidelines, those who are dual eligible could be affected.

“Because each state will have a different outcome based on lots of different things,” Cabanillas pointed out. “From a Medicaid perspective, it can be about whether or not they expanded Medicaid, could change what it’s going to look like in the future.”

Caregivers for dual eligible people who are Medicaid could also lose coverage. Wisconsin is one of 10 states to not expand its Medicaid program under the Affordable Care Act, where 15% of the state’s 1.2 million Medicare recipients in Wisconsin are also on Medicaid.

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