Key Takeaways

• Dual eligible clients often have more complex needs than standard Medicare beneficiaries, but many agents underestimate the opportunity.

• Misunderstandings about Medicaid levels, enrollment timing, and plan switching can cost you trust, enrollments, and long-term clients.

What ‘Dual Eligible’ Really Means

Dual eligible beneficiaries are those who qualify for both Medicare and Medicaid. In 2025, these clients represent a significant and growing segment of the market. But to serve them well, you need to understand the nuances.

Medicare provides coverage for medical services like hospital and doctor visits, while Medicaid may cover premiums, copayments, and additional services like long-term care, transportation, or dental care, depending on state-level rules. The level of Medicaid someone qualifies for significantly impacts their options—and your approach.

There are two basic categories of dual eligibles:

• Full Dual Eligibles: Receive full Medicaid benefits, often including help with premiums, deductibles, and extra services.

• Partial Dual Eligibles: Get help with Medicare costs (like premiums) but do not receive full Medicaid services.

If you confuse these categories, you risk presenting a plan that doesn’t meet their needs or that they can’t even enroll in.

Why This Market Is Bigger Than You Think

As of 2025, there are over 12 million dual eligible individuals in the United States. This number is projected to grow with aging demographics and economic hardship. Most agents don’t focus here because of perceived complexity or assumptions about low ROI. That’s a mistake.

Dual eligibles often:

• Qualify for Special Enrollment Periods (SEPs) throughout the year

• Receive additional subsidies, making coverage more attractive

• Require more personalized service, which fosters stronger retention

When you understand how to reach and support these clients, you open a consistent pipeline of enrollments year-round.

Common Mistakes Agents Still Make

Many licensed agents miss opportunities with dual eligibles due to outdated information or a lack of proper training. The most common errors include:

• Assuming all dual eligibles have the same Medicaid level

• Failing to verify Medicaid status at the state level

• Missing Special Enrollment Period (SEP) eligibility

• Misunderstanding cost-sharing protections

In 2025, SEP rules allow dual eligible clients to make one plan change per calendar quarter in the first three quarters of the year. That’s January to March, April to June, and July to September. From October onward, changes follow the Annual Enrollment Period (AEP) rules unless they qualify for a different SEP.

If you’re not tracking this timeline accurately, you’re either missing enrollments or confusing your clients.

The Opportunity Hidden in Quarterly SEPs

These quarterly enrollment windows are a goldmine if you know how to manage them. Many agents ignore this flexibility, which leaves clients underserved.

Here’s how you can make the most of it:

• Stay in regular contact with dual eligible clients to update them on potential changes

• Use each quarter’s SEP to re-evaluate their plan based on current needs and coverage performance

• Educate clients on their rights so they trust you to manage their benefits long-term

The SEP timeline is especially helpful when a client is unhappy with their plan or has newly qualified for dual eligibility.

Understanding Extra Help and LIS Tiers

Dual eligible clients almost always qualify for Extra Help, also known as the Low-Income Subsidy (LIS). But agents frequently misunderstand how this works.

There are four LIS tiers. Each provides a different level of subsidy for Part D prescription drug costs. Clients at higher LIS levels pay less for their medications. In 2025, those who qualify for full LIS may see no deductible and limited cost-sharing, with consistent access to prescriptions.

Misjudging a client’s LIS level can result in recommending the wrong plan. Always confirm LIS status through Medicare systems or authorized state portals.

Building Trust With the Right Questions

Dual eligible clients may have limited experience navigating complex insurance systems. They also may be more skeptical due to prior misinformation or inconsistent support.

When working with them:

• Ask about both their Medicare and Medicaid cards

• Confirm their eligibility through your verification systems before making plan recommendations

• Focus on listening rather than pushing plans too early

The more precise your fact-finding, the better the fit. And the more confident your client feels in trusting you to manage their benefits.

A Client Base That Stays With You Longer

Dual eligible clients aren’t usually switching agents year after year. In fact, when you serve them well, they often stay with you for the long haul.

This loyalty happens because:

• They value personalized guidance more than product variety

• They appreciate year-round access to support

• Their needs evolve, and you stay with them during transitions

In other words, when you serve this population with care, your retention and referral rates can rise dramatically. Dual eligible clients may also live in close-knit communities—meaning word-of-mouth matters more than ads.

Compliance Still Matters—Even With SEPs

Just because you can enroll dual eligible clients quarterly doesn’t mean compliance rules are relaxed. You’re still expected to:

• Use CMS-approved materials

• Document consent-to-contact and scope of appointment

• Record calls as per current CMS guidance

Compliance slip-ups are especially risky in this segment because clients may not report problems until after damage is done. Err on the side of over-documentation.

Plan Comparisons Must Be Tailored

It’s not enough to run a general comparison tool. Dual eligible clients often need:

• Coordinated care models that align with Medicaid services

• Access to local provider networks that accept both Medicare and Medicaid

• Extra benefits that are actually usable in their location

Generic plan comparisons may look good on paper but fail in real-life execution. Take time to explore how each plan performs at the county or ZIP code level.

How to Organize Your Book for Dual Eligible Clients

You’ll want a dedicated system to manage these clients because their timelines and needs are different. Some strategies that help include:

• Segmenting your CRM based on Medicaid levels

• Setting calendar reminders for quarterly SEP outreach

• Tracking LIS tier changes and renewal statuses

If you’re using automation tools, customize workflows to trigger check-ins based on upcoming SEP eligibility. That way, you’re never caught off guard.

Why Your Marketing Needs a Different Tone

Standard Medicare marketing often doesn’t land with dual eligible audiences. You’ll need a softer, more educational approach. That includes:

• Language that avoids jargon and focuses on benefits

• Outreach methods that consider digital access limitations

• Community-based efforts like attending local health fairs

Your marketing doesn’t need to be flashy—it needs to be accessible. Focus on trust, reliability, and clarity.

Elevating Your Role From Agent to Advocate

If you’re serious about growing in this space, your mindset matters. The best agents serving dual eligible clients act as advocates, not just enrollers. That means:

• Educating clients about Medicaid renewals and redeterminations

• Helping them access transportation or community-based services

• Checking in even when there’s no enrollment opportunity

When clients see you as a reliable guide, they don’t shop around.

Serving Dual Eligibles Strengthens Your Business

You don’t need to avoid dual eligible clients. You need to understand them.

This is a year-round market with unique needs and higher loyalty potential. When you serve it well, you:

• Keep your sales pipeline active outside of AEP

• Build lasting client relationships

• Expand your local reputation as a trusted expert

If you’re ready to streamline your outreach and grow in this niche, we can help. At BedrockMD, we support agents like you with compliant automation, training on dual eligible outreach, and tools that simplify retention.

Sign up today and start building a book of clients who stay with you—and refer others.