Medicare dual eligible
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Medicare dual eligibles, in the Medicare system of the United States, are Medicare Part A and/or B recipients who either [1] qualify for a Medicare Savings Programs (MSP) or [2] qualify for Medicaid benefits. Dual eligibles generally qualify for the QMB benefits, in which the beneficiary's non-Medicare coverage is covered by Medicaid, effectively providing full health care coverage. With the advent of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, these dual eligibles have automatically been enrolled to a random Medicare Part D plan, effective January 1 of 2006. As a result of this auto assignment, participants who were already enrolled in a Medicare Advantage HMO, may have been automatically disenrolled from their medical plan to allow for part D enrollment. Medicaid will still cover drugs for dual-eligible patients that are not covered by Medicare Part D, including certain controlled substances. Pharmacies know by automation who these patients are. Individuals that qualify for dual eligibility will be paid first by Medicare and the remainder will be paid by Medicaid. [1]
Section 231 of the Medicare Modernization Act of 2003 created a new type of Medicare Advantage coordinated care plan focused on individuals with special needs called the the Medicare Advantage Special Needs Plans (SNP) program. "Special needs individuals" were identified by Congress as: 1) institutionalized; 2) dually eligible; and/or 3) individuals with severe or disabling chronic conditions. SNPs must offer care to the unique needs of low-income, chronically ill, and institutionalized Medicare beneficiaries. Given their expertise in serving these populations, many Medicaid managed care plans also offer SNPs to serve dual eligibles. The program was set to expire in 2008 and has since received short term authoriztions from Congress.
[edit] References
[edit] External links
- Dual eligibles entry on Medicare.gov glossary of terms page
- Medicare & You handbook (PDF) on Medicare.gov — see pages 49 (59 of 104) and 58 (68 of 104) for more complete information
- Medicare / Medicaid Dual Eligibles information from cms.hhs.gov
- Dual Eligible FAQ for claims processing by pharmacist (PDF) from cms.hhs.gov
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