Medicaid Eligibility
Levels
Levels
The additional "coverage" someone has to have, to be eligible for a DSNP plan
What is Medicaid?
A Joint federal and state program that provides health coverage to low-income adults, children, pregnant women, elderly adults and people with disabilities.
What is Medicaid?
The election period when someone is eligible for Medicare for the first time
What is the IEP (Initial Eligibility Period)
Many DSNP plans offer this benefit to provide assistance in getting members to and from scheduled appointments.
What is the non-emergency transportation benefit?
The Medicaid level that only pays for the Part B premiums and is on a first come first served basis and is subject to annual caps.
What is QI (Qualified Individual)?
A specialized Medicare Advantage plan designed for individuals who qualify for both Medicare and Medicaid.
What is a DSNP plan?
When a DSNP member loses their current Medicaid level that is needed to qualify for their DSNP plan. They qualify for a ___ period
What is SEP (Special Enrollment Period)
This monthly or quarterly allowance helps members purchase health related items.
What is the OTC benefit?
The Medicaid level that pays the Part B premiums only BUT is guaranteed enrolled if eligible.
What is SLMB? (Specified Low-Income Medicare Beneficiary)
One of the main deciding factors if an induvial qualifies for a DSNP Plan?
What is a Medicaid level?
How frequent are DSNP plan holders able to change their plan voluntarily per quarter?
ONCE each quarter
A member with FULL Medicaid benefits often times for in formulary prescriptions.
What is zero, nada, zilch, or nothing? (may be subject to change from CMS VBID in 2026)
The Medicaid level that covers the Medicare B premium, deductibles copays and coinsurances. But only has Medicare cost sharing and does NOT have full Medicaid benefits included (Dental, vision, long term care)
What is QMB?
A private health insurance company contracted by the state to provide Medicaid benefits and services
What is a MCO (Medicaid Managed Care Organization)
True or False: If a DSNP member changed their plan June 31s and calls in on July 31st to switch to a different DSNP with greater benefits they DO qualify for they would be approved.
False: June 31st does not exist (DSNP plans can change ONCE per quarter, if 30 day grace period passes after plan change they must wait to next quarter to change if they do not qualify for a SEP)
Some DSNP plans offer this benefit to improve safety and accessibility in their homes.
What is the home modification benefit?
All of the Medicaid Levels that an individual can have to potentially be considered for a DSNP plan.
What is QI, SLMB, SLMB+, QMB, QMB+, FBDE
In 2026, this CMS program—once responsible for enabling D-SNPs to offer enhanced benefits credits for food and utilities—will be discontinued, requiring plans to verify chronic conditions to continue offering similar perks.
What is the VBID (Value Based Insurance Design) model
True or False: DSNP members can only change their plan if they qualify for a SEP, or during their IEP, AEP or MA-OEP
False: DSNP member can voluntarily change their plan if they elect to once per quarter
DSNP plans may connect members to housing, legal aid, or community programs through this type of support.
What are social service referrals?