Traditional MedicareCoverageMedium impact
Medicare Coinsurance Policies Not Allowed for Dual-Eligible Individuals
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jan 22, 2015
We identified it
Jun 20, 2026
Summary
Dual-eligible individuals (those with both Medicare and Medicaid) are prohibited from being sold Medicare coinsurance/Medigap insurance policies under federal law. An exception exists only if the policy was in place before the individual became Medicaid-eligible.
Action Required
Immediately: Billing and eligibility verification teams must identify dual-eligible patients (those with both Medicare and Medicaid) and ensure no Medigap policies are being processed for these individuals unless the policy predates their Medicaid eligibility. Update patient insurance verification procedures to flag dual-eligible status and prevent inappropriate Medigap billing.