Dual Jeopardy

Types of Dual Eligibles

100

Has full medicaid benefits

What is a Full Dual?

200

Have some medicare cost share coverage through medicaid 

What is a partial dual?

300

Is a member who is eligible for both Medicare and Medicaid, but they only have one or the other of the coverages with Elevance

What is a DE/Dual Eligible?

400

Is a member who has both their Medicare and Medicaid coverage with Elevance

What is a DC/Dual Citizen?

500

A member who chooses to have both their Medicare and Medicaid with Elevance through a plan that integrates their Medicare and Medicaid benefits into a single Medicare enrollment.

What is Integrated?

Types of DSNPs

100

Similar to today’s DSNPs outside of NJ, TX and FL, Data Sharing DSNPs require coordination with the state Medicaid agency or Medicaid Managed Care Organization (MCO). There is zero integration.

• Members will have an ID card for their DSNP and a separate ID card for their Medicaid plan.  
• If permitted by the state, Partial Duals may enroll in these plan

What is Data Sharing DSNP?

200

1. Both Medicare and Medicaid with ANTM, or
2. Medicare with ANTM and Medicaid with another health plan (e.g., United, Aetna). Because the plan allows for a mixture of members, the Unaligned HIDE is not integrated

What is a unaligned HIDE?

300

is an integrated plan, meaning all members get both Medicare and certain Medicaid benefits (as defined by the state contract)

What is an aligned HIDE?

400

CMS requires this type of SNP (or its parent organization or an entity owned/controlled by its parent organization) to have a contract with Medicaid to offer BH and/or LTSS benefits

What is a HIDE/Highly Integrated Dual Eligible SNP?

500

CMS requires this type of SNP to have a contract with Medicaid to offer LTSS benefits. It is a fully integrated plan, so all members get their Medicare and Medicaid benefits through it.  

• Members get one ID card that would be used for both Medicare and Medicaid benefits. There is one uniform grievance and appeals process (i.e., there is not a separate process for Medicaid services).
• Partial duals are not allowed to enroll in these plans.

What is a FIDE/ Fully Integrated Dual Eligible SNP?

Miscellaneous

100

This type of bird is is a symbol of strength and freedom, known as the national bird of the United States 

What is a bald eagle?

200

This mountain is considered the highest mountain in the world

What is Mount Everest?

300

This is considered the federal capital of the United States

What is Washington, D.C?

400

You should use this tool on all calls

What is the HIPPA tool?

500

This new enhancement should be used on all calls

What is the chatbot?