MRS. W'S STORY
Covered With No Way to Reach Specialist Care
Health insurance is complicated enough when it’s provided by a single plan. People like Mrs. W, a 68-year-old dually eligible for Medicare and Medicaid, have to navigate a patchwork of coverage offered by both.
When Mrs. W switched to a coordination only dual-eligible special needs plan, the lowest standard of integration, she didn’t get the more seamless experience she was promised. While she retained transportation services for Medicaid benefits, she lost access to transportation to specialist appointments covered by Medicare. The complex rules governing how the two programs cover care for those who are dually eligible meant that fixing the problem for some of her transportation needs risked disrupting the coverage that was working for her.
People who are dually eligible should have meaningfully integrated coverage that ensures Medicare and Medicaid feel like one program.
