Interpreter Bulletin: 2024 CMS Mystery Shoppers - Dual Coverage -

Medicare and Medicaid

Issue 473 (All Languages): April 11, 2024

Overview
One of our largest clients is the Centers for Medicare and Medicaid. Additionally, many of
our clients are contracted with CMS to provide Medicare and Medicaid coverage.

Dual Coverage – Medicare and Medicaid

Medicaid is funded by both the state and federal governments to provide health insurance to
low-income people and those in dire need. States manage their own Medicaid programs and
determine eligibility. Children, pregnant women, elderly, blind, and/or disabled people are
eligible for Medicaid.
The name of the Medicaid program is different in some states. For example, in Arizona,
Medicaid is called "AHCCCS" (pronounced “access”). In California, Medicaid is referred to as
"Medi-CAL."
CHIP (Children's Health Insurance Program) is a program that works closely with Medicaid
and provides coverage to children.

Important Note: California Medicaid

When interpreting calls for LEPPs living in California, don't get confused between "Medical"
and "Medi-CAL."

Just as Medicare has contracts with private companies to provide benefits, so does
Medicaid.
States contract private insurance companies to manage their members' benefits.
Many of these private insurance companies are our clients. That’s why, for example, you
may get a call from “Molina Medicaid.”

Dual Coverage – Primary vs Secondary Insurance

In some cases, people have both Medicare and Medicaid. This is considered “dual coverage.”
This is most common for elderly people who are low-income and younger people with
disabilities. When a beneficiary has two different types of insurance:
• One insurance is primary
• The other insurance is secondary
When a person has dual coverage:
• Medicare is the primary insurance and is billed first by the doctor.
• Anything not paid by the primary insurance is sent to Medicaid, the secondary
insurance.

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© 2024 CyraCom International, Inc. All rights reserved. (04.11.2024)
People who have both Medicare and Medicaid may also be eligible for other programs, such
as Extra Help or the Medicare Savings Program.
Extra Help assists with drug coverage costs. The Medicare Savings Program helps pay for
Medicare premiums, deductibles, coinsurance, and copayments.
Medicaid and Medicare sound very similar and both names may be referenced throughout a
call. Whenever you are not sure if the Client or LEPP said Medicare or Medicaid, please
double check to verify. When interpreting, please ensure you clearly enunciate these names.
You will hear references to both Medicare and Medicaid on CMS Mystery Shoppers calls.
Please make sure you’re clear on the difference between the two!

Dual Coverage - Terminology

English Translation
Arizona Health Care Cost Containment System
(AHCCCS)
billed

Children’s Health Insurance Program (CHIP)

contracts
dire need
disabled
dual coverage
elderly

eligibility

Extra Help

federal government
low-income
Medicaid
Medi-CAL

Medicare Savings Program

primary
private company
secondary

Interpreter Bulletins – 2024 CMS Mystery Shoppers – Dual Coverage – Medicare and Medicaid – All Languages Page 2 of 2
© 2024 CyraCom International, Inc. All rights reserved. (04.11.2024)