MEDICARE/MEDICAID

Medicaid basics

• A federal and state program providing health coverage to millions of Americans: eligible low-income adults, children, pregnant women, elderly adults and people with disabilities
• Administered by states, according to federal requirements
• Funded jointly by states and the federal government
• If an individual is eligible for both Medicare and Medicaid, MAPD plans, specific to this qualification, are
  referred to as Medi/Medi or Dual-Eligible plans
  Note: Dual-Eligible individuals can enroll in any plan, not just the SNP plan.
• Impacts medical and prescription drug costs
• Applies to certain areas where a Special Needs Plan is available
  Note: SNPs are not offered in all markets.
• Depending on income, some clients might qualify for both LIS and Medicaid

Sources: 1 Extra Help with Medicare Prescription Drug Plan Costs. (n.d.). Retrieved February 5th 2020, from https://www.ssa.gov/benefits/medicare/prescriptionhelp/

Keep in mind: LIS is not the same as Medicaid

• LIS is a federal subsidy program
• LIS impacts prescription drug costs: premiums, deductibles and copays.
• Applies to most MAPD and PDP plans available from Humana.

Who qualifies for extra help (LIS)?

Annual income

• >$17,226 (individual) or $23,274 (couple)
• Might still qualify if annual income’s higher in special cases

Resources/assets

• >$7,860 (individual) or $11,800 (married and living together)

All who qualify must have original Medicare Parts A and B and reside in one of the 50 states or the
District of Columbia.

Source: https://www.ncoa.org/wp-content/uploads/part-d-lis-eligibility-and-benefits-chart.pdf

DSNP: Dual-eligible special needs plan

This special Medicare Advantage plan type is limited to people who qualify for both Medicare and Medicaid. The
benefits, provider choices and covered drugs are designed to meet the unique needs of this undeserved group.
Note: Not all prospects who are considered dual eligible may be at the level of eligibility that qualifies them for the SNP plan.

Who is eligible?

Anyone over 65 or on disability is generally eligible for Medicare; Medicaid assistance is provided based on financial need.

Why a DSNP might be better than regular Medicare Advantage (MA).

DSNPs may offer more benefits than clients are receiving now at low- or zero-dollar premium plans, because they
include MA coverage and work with state Medicaid programs. Please keep in mind that Dual Eligibles can enroll in
any Medicare Advantage plan they choose, but they may find added value in the DSNP plans.

Services your clients may receive through Medicaid:

• Long-Term Care (LTC), including nursing facilities and waivers
• Routine (not covered by Medicare): dental, vision, hearing, non-emergency medical transportation*
• Prescribed meds not covered by Part D and some over-the-counter (OTC) meds

Some DSNP plans may include benefits
beyond regular HMOs, such as:

• Dental coverage
• Vision
• Fitness programs
• Hearing
• OTC
• Prescription coverage
• New: Healthy Foods Card* (see next page)

*Allotted food allowance based on plan.

New in 2020: Healthy Foods Card*

• The Healthy Foods Card benefit provides either a $25 or $50 allowance every month for members to purchase healthy groceries.
• The Healthy Foods Card can be used at 50K+ retailers nationally (reach out to your BRM for more information on retailers who will be accepting the benefit in 2020).
• The card allowance does not roll over from month to month. The $25 or $50 will reload, each month,
  per the plan benefit.

The Healthy Foods Card benefit is offered on select 2020 DSNP only plans. Its goal is to modernize Medicare Advantage through lowering cost, improving health outcomes and enhancing the quality of care for Medicare
beneficiaries.*

*Allotted food allowance based on plan.