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Duals: Medicaid and Medicare

Medicare Advantage Dual Eligible

Created Date 08.12.19
Last Updated 08.13.19
Viewed 4 Times
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  • 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