Last updated December 21, 2023
When to use:
Caller is eligible for both Medicare and Medical Assistance and needs information about various Medicare Savings Programs (QMB, SLMB, QI, QDWI) or Managed Care options (MSHO, MSC+, SNBC, and/or D-SNP).
What are Dual Eligible Beneficiaries?
“Dual eligible beneficiaries” describes beneficiaries eligible for both Medicare and Medical Assistance. The term describes beneficiaries enrolled in Medicare Part A and/or Part B who are also receiving full Medical Assistance benefits and/or those who are only eligible for assistance with Medicare premiums or cost sharing through one of these Medicare Savings Program (MSP) categories:
- Qualified Medicare Beneficiary (QMB) Program: Helps pay premiums, deductibles, coinsurance, and copayments for Part A, Part B, or both.
- Specified Low-Income Medicare Beneficiary (SLMB) Program: Helps pay Part B premiums
- Qualifying Individual (QI) Program: Helps pay Part B premiums
- Qualified Disabled Working Individual (QDWI) Program: Pays the Part A premium only for certain disabled and working beneficiaries (very rare)
Medicare pays covered medical services first for dual eligible beneficiaries because Medical Assistance is generally always the payer of last resort. Medical Assistance may cover medical costs that Medicare may not cover or only partially cover, such as skilled nursing facility (SNF) care, home care, personal cares, custodial care and/or home- and community-based services through a waiver. Medical Assistance also covers the deductibles, coinsurance and copayments if there are costs not covered by Medicare.
Eligibility guidelines for Medical Assistance and all MSPs are established by the State of Minnesota and change July 1st of each year. Current income and asset eligibility guidelines are maintained on the Financial assistance for people with low to modest income quick reference.
Senior LinkAge Line serves as the primary resource in Minnesota for all Minnesota Medicare beneficiaries who are interested in applying for a Medicare Savings Program. Application must be made via a paper application and not online. Application for Certain Populations
Managed Care for Dual Eligibles Coverage Choices:
Managed care is a service delivery model in which the health plan is paid directly from the Department of Human Services (DHS) to provide health care services to members enrolled in that health plan. This is different than the service delivery model of fee for service (FFS) in which the health care provider receives payment from DHS directly to provide health care services.
Within managed care, there are different programs that are designed for specific populations based on their needs. However, the four listed below all:
- Has a network of providers.
- Require the beneficiary to remain in the plan’s service area to stay enrolled.
- Depending on the plan, may offer extra benefits like routine dental, vision, hearing coverage, gym memberships beyond what is already covered by Medical Assistance, and/or Medicare if enrolled.
- Provides for Waiver services.
In most situations, if a person aged 65 or older is eligible for Medical Assistance, they must get their Medical Assistance benefits through a managed care plan such as MSHO or MSC+.
Minnesota Senior Health Options (MSHO):
Minnesota Senior Health Options (MSHO) are a type of Medicare Advantage Special Needs Plan (MA-SNP), available through private insurance companies that contract with Medicare and the state Department of Human Services. MSHO plans are managed care plans that combine separate health care programs and support systems into one plan. It includes all Medical Assistance benefits and Medicare Part A, Part B and Part D coverage.
MSHO Considerations:
- Can be in a nursing home and enroll in MSHO.
- Enrollment into another Medicare Advantage option or separate Part D plan will disenroll the enrollee from the MSHO plan.
- Assigned a care coordinator who helps them get their health care and related support services.
Minnesota Senior Care Plus (MSC+):
Minnesota Senior Care Plus (MSC+) plans are managed care plans that manage only the Medical Assistance benefits, including waiver benefits. They do not incorporate Medicare Part A, B and D benefits into the plan. MSC+ enrollees who are eligible for Medicare will continue to receive Original Medicare Benefits through fee for service Medicare, and need to enroll in a separate Medicare Part D plan, or they will be without most prescription drug coverage. Their Medicare Part A and B services will be covered under fee-for-service in most situations, with most Medicare cost sharing being paid for Medical Assistance.
MSC+ Considerations
- If beneficiary has Medicare coverage, a separate Part D plan will need to be obtained to cover prescription costs.
Special Needs Basic Care (SNBC):
Plans are voluntary managed care plans for people with disabilities who are age 18-64 and are eligible for Medical Assistance. Some SNBC plans only cover Medical Assistance benefits; however, if the beneficiary has Medicare, they should consider enrolling in an Integrated SNBC plan that includes Medicare to receive all benefits through one managed care organization, if available in their county.
Special Needs Basic Care (SNBC) (non-integrated)
SNBC (non-integrated) Considerations
- If someone under 65 contacts the SLL for help with Medicare Part D, staff need to check MMIS for MA and if they have managed care through a Special Needs Basic Care (SNBC) plan.
- Need to check to see if they are eligible for Medicare. If they have Medicare find out if they have a Part D drug plan.
- They have to have MA to have SNBC.
- If they do not have a managed care plan, they are in Fee-for-Service (FFS) plan and will need a Part D stand-alone prescription drug plan.
- The non-integrated SNBC plan requires a Part D stand-alone prescription drug plan.
Special Needs Basic Care (SNBC) – Integrated
Integrated SNBC Considerations:
- Integrated SNBC plans are advantage plans that include Medicare Part A, Part B, Part D, and Medical Assistance benefits coverage.
- Assigned a care coordinator who helps them get their health care and related support services.
- When enrolled into the Integrated SNBC, if they enroll into a Part D plan, they will automatically be disenrolled from the Medicare side of their SNBC plan coverage. Ask the person if they want to disenroll from their Integrated SNBC plan. If so, proceed with the Part D enrollment. They should also contact the plan if they want to continue with non-integrated SNBC with the same company.
Refer people to the Disability Hub for SNBC benefits counseling if they do not need help with Part D.
Dual Eligible Special Needs Plan (D-SNP):
Dual Eligible Special Needs Plans (D-SNP) provide benefits and services to people with Medical Assistance and Medicare. These are infrequently utilized but remain an option for certain duel eligibles with specific health concerns or living arrangements.
- D-SNPs include care coordination services and tailor their benefits, provider choices, and list of covered drugs (formularies) to best meet the specific needs of the groups they serve.
- SNPs are either HMO or PPO plan types, and cover the same Medicare Part A and Part B benefits that all Medicare Advantage Plans cover. However, SNPs might also cover extra services for the special groups they serve. You can only stay enrolled in an D-SNP if you continue to meet the special conditions of the plan.
SNP (D-SNP) Considerations
- Need to check to see if the person is eligible for Medicare and what D-SNP they are enrolled in.
- D-SNP include MSHO plans and separate D-SNPS that are not MSHO plans. They cover all Medicare and Medical Assistance benefits, including care coordination and waiver services. Enrollees must use providers that participate with the plan, unless emergency services are needed.
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