Duals: Medicaid and Medicare
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Medicare Advantage Dual Eligible
Topics of this game:
- Member has more than one Anthem plan
- Member is eligible for Medicare and some form of Medicaid
- Medicaid pays all Medicare costs including Part D. members may qualify for additional Medicaid benefits.
- Medicaid pays all Medicare Premiums, Deductibles, Copays, Coinsurance except Part D.
- The only state to have crossover claims
- The state that has MLTSS Benefits and is called a FIDE
- This state has LTSS benefits and their Medicaid is called TennCare
- When members have both Medicare and Medicaid which is Primary
- A Texas Delegated risk group
- HMO plans in this state do not require PCP's on file
