Key Takeaways

• Dual-eligible clients—those who qualify for both Medicare and Medicaid—require deeper engagement than a templated enrollment script can provide. Their care needs are complex, and your ability to listen and tailor solutions will set you apart.

• In 2025, CMS continues to promote integrated care models and managed care plans tailored to dual eligibles. Understanding these evolving structures can make you a better advocate and trusted advisor.

Understanding the Dual-Eligible Population

Dual-eligible individuals are among the most vulnerable Medicare beneficiaries. In 2025, there are over 12 million people in the U.S. who qualify for both Medicare and Medicaid. They often live with multiple chronic conditions, low incomes, limited social support, and complex medication regimens.

Unlike standard Medicare clients, dual-eligible beneficiaries receive coverage from two different systems: federal Medicare and state-administered Medicaid. This unique intersection creates both opportunities and complications when it comes to delivering value.

As a licensed agent, your responsibility extends beyond compliance. Serving dual-eligible clients well means knowing how these systems overlap, where gaps exist, and how to help clients get the most out of both.

Go Beyond the Basics: Know the Dual Eligibility Types

CMS classifies dual-eligible beneficiaries into two major categories:

• Full-benefit dual eligibles: Receive full Medicaid benefits in addition to Medicare. Medicaid helps cover costs such as premiums, deductibles, and long-term care services.

• Partial-benefit dual eligibles: Receive help with Medicare premiums or cost-sharing but not full Medicaid benefits.

In 2025, states may also have different names or subcategories for programs that support partial dual eligibles—like QMB (Qualified Medicare Beneficiary), SLMB (Specified Low-Income Medicare Beneficiary), and QI (Qualifying Individual).

Knowing which category your client falls into directly affects plan eligibility, benefit coordination, and support services available.

Compliance Still Matters—But Context Matters More

Yes, compliance matters. You must follow the CMS rules on disclosures, call recording, and benefit explanations. But with dual eligibles, a mechanical, script-based approach is not enough.

You need to:

• Pause often to confirm understanding.

• Ask layered questions to uncover hidden needs.

• Educate patiently, especially on differences between Medicare and Medicaid benefits.

In 2025, CMS encourages culturally competent communication. That means explaining benefits in a way that fits your client’s language, education level, and comfort zone. Scripts can be a starting point, but personalization is the priority.

Integration Is the Trend—Are You Keeping Up?

One of the biggest shifts happening now is the expansion of integrated care models like:

• DSNPs (Dual Eligible Special Needs Plans): These coordinate Medicare and Medicaid benefits.

• FIDE SNPs (Fully Integrated Dual Eligible SNPs): Offer an even deeper level of alignment between federal and state services.

By mid-2025, more states are mandating or incentivizing enrollment into integrated plans to improve outcomes and reduce fragmentation. These models reduce confusion and help clients get more streamlined services.

You don’t need to be a policy expert, but you should understand which integrated options are available in your state and how they compare to non-integrated plans. Clients will lean on your clarity.

Financial Protections Matter to This Market

Dual-eligible clients often live below or near the federal poverty level. That means even small out-of-pocket costs can prevent access to needed care.

You should be well-versed in:

• Medicaid cost-sharing rules (varies by state)

• Extra Help for prescription drugs under Medicare Part D

• $2,000 Part D annual out-of-pocket cap in 2025

• State pharmaceutical assistance programs (if available)

These financial protections should be part of your conversation—not just to close a sale, but to build trust. When you show awareness of these barriers, you show that you understand what matters.

Help Clients Avoid Churn and Coverage Gaps

Many dual eligibles experience frequent life changes: moving, income fluctuations, hospitalization, or loss of Medicaid eligibility. These shifts can disrupt coverage.

Here are a few strategies to help them stay covered:

• Educate clients on Special Enrollment Periods (SEPs) that apply to duals (they can change plans once per calendar quarter for the first three quarters of each year)

• Encourage annual Medicaid renewal and help them understand how to provide updated income or residency documentation

• Explain how losing Medicaid may change their Medicare options or drug coverage

You are more than a plan recommender. You can be a continuity anchor for your clients’ coverage.

Cultural and Health Literacy Gaps Are Real

In 2025, the push for health equity continues. CMS and states are placing stronger emphasis on reaching underserved populations with accessible education.

Your dual-eligible clients may face:

• Language barriers

• Low literacy levels

• Mistrust of institutions

Here’s what you can do:

• Offer interpretation services or translated materials when needed

• Use plain, simple language free of insurance jargon

• Encourage trusted family or caregivers to join plan discussions

Building rapport and clarity is worth the extra time. These are not one-call clients. They are relationship clients.

Training Makes the Difference

If you’re serious about working with this population, get trained beyond the basics:

• Take continuing education courses focused on dual eligibility

• Study your state’s Medicaid waiver programs and long-term care services

• Stay up to date on your state’s Medicaid expansion and integration efforts

Many agencies in 2025 offer dual-eligible certifications, webinars, and CMS learning modules. Invest in those. It will pay off in both professionalism and client outcomes.

When Selling Isn’t the Point—But Service Is

Sometimes, you’ll spend 45 minutes on the phone with a client only to realize they don’t need a new plan. That doesn’t mean it was wasted time.

For dual eligibles, your service may include:

• Helping access care coordination services

• Referring them to social services or community programs

• Explaining how to use over-the-counter benefits or transportation

You’re building a reputation for reliability. That reputation creates word-of-mouth growth. In 2025, a service-first mindset is what keeps your book of business loyal and growing.

Technology Helps—But Only if It Simplifies

You may be using CRMs, quoting tools, and call tracking software. But when working with dual eligibles, tech should help you slow down, not rush through.

Look for systems that:

• Provide reminders for Medicaid redeterminations

• Let you track SEP eligibility windows

• Allow custom notes and care coordination contacts

Automation is great, but personalization is non-negotiable. Don’t let templates replace genuine care.

How We Can Help You Serve the Duals Market Better

Dual-eligible clients deserve more than a transaction. They deserve a professional who understands their needs and helps them navigate both systems with care and consistency.

That’s why we built BedrockMD—to support agents like you.

With our platform, you get:

• Smart automation that keeps track of SEP windows, Medicaid recertification dates, and care gaps

• Access to resources to better educate and retain your dual clients

• CRM tools that don’t just sell—they support follow-up and service

Sign up today and let us help you serve this important market with the respect and structure it deserves.