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Dual Advantage Plan

Care Improvement Plus Dual Advantage Plan

Care Improvement Plus' Dual Advantage Special Needs Plan (Regional PPO SNP)(PPO SNP) is uniquely designed for Medicare beneficiaries with both Medicare and full Medicaid (dual eligible), providing access to comprehensive Medicare and Medicaid benefits, plus valuable supplemental services in a single plan.

Care Improvement Plus' Dual Advantage plan features
  • $0 monthly plan premium for those who have Medicare and full Medicaid
  • $0 cost sharing (no copayments, coinsurance or deductibles) for most Medicare-covered medical services, for those who have Medicare and full Medicaid
  • Vision benefits
  • Dental coverage
  • Transportation benefits
  • Podiatry care
  • Nursing support
  • Preventive health care
  • Emergency care
  • Durable Medical Equipment benefits
  • Social Service Coordinators – helping members better manage out-of-pocket expenses for health care, prescription drugs, utility bills and more.

Why offer a health plan for those with both Medicare and Medicaid?

Care Improvement Plus currently covers more than 49,000 beneficiaries with Medicare and Medicaid benefits. For these beneficiaries, it can be confusing to understand what is covered by Medicare and Medicaid. Care Improvement Plus Dual Advantage offers support services to help dual-eligible beneficiaries access more benefits, coordinating their care and ensuring that they obtain necessary services.

Key Dual Eligible Beneficiary and D-SNP Statistics:
  • According to CMS data, approximately 9 million beneficiaries are considered dual-eligible.1
  • Dual-eligible beneficiaries make up 18 percent of the Medicare population, however they are 31 percent of Medicare spending2
  • The average total spending for dual eligible’s was about $26,800, almost double the spending of other Medicare beneficiaries2
  • 51 percent of the dual eligible population lives below the poverty level2
  • As of August 2010, more than 1 million Medicare beneficiaries are enrolled in dual special needs plans. 3
  • Dual eligibles account for 18 percent of total Medicaid enrollment (8.8 million individuals), but 46 percent of Medicaid spending4, 5

Sources



This page was last updated on: 8/23/2011 10:48:57 AM
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Care Improvement Plus is a Medicare Advantage organization with a Medicare contract. The Care Improvement Plus contract with CMS is renewed annually and coverage availability beyond the end of the current contract year is not guaranteed. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2013.

The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. For more information contact the plan. To be eligible for a Care Improvement Plus plan you must be a Medicare beneficiary living in Arkansas, Georgia, Missouri, South Carolina, Texas and select counties in Illinois, Iowa, Indiana, Maryland, New Mexico, New York, Wisconsin and have both Medicare Part A and Part B to enroll.

To be eligible for a Care Improvement Plus Chronic Conditions Special Needs Plan, you must have diabetes and/or heart failure. To be eligible for Care Improvement Plus Dual Advantage, you must be enrolled in state Medicaid and be a dual eligible beneficiary whom the State holds harmless for Part A and Part B cost sharing.

Members may enroll in the plan only during specific times of the year. Contact Care Improvement Plus for more information. If you have diabetes, heart failure, or Medicaid/Low Income Subsidy, you may qualify to enroll in a Care Improvement Plus Special Needs Plan ANYTIME of the year by exercising a “Special Election Period.

You must continue to pay your Medicare Part B premium. If you are a full benefit dual beneficiary and your Part B premium is paid for by the State, you will not be responsible for paying your Part B premium. Premiums, copays, coinsurance and deductibles may vary based on the level of help received. Limitations, copayments and restrictions may apply.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

  • 1–800–MEDICARE (1–800–633–4227). TTY users should call 1–877–486–2048, 24 hours a day/7 days a week;
  • The Social Security Office at 1–800–772–1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1–800–325–0778; or
  • Your State Medicaid Office.

People with limited incomes may qualify for extra help to pay their prescription drug costs. If eligible, Medicare could pay for 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this extra help, contact your local Social Security office, or call Social Security at 1–800–772–1213.TTY users should call 1–800–325–0778. You can also apply for extra help online at www.socialsecurity.gov/prescriptionhelp. If you qualify for extra help with your Medicare prescription drug coverage costs, Medicare will pay all or part of your plan premium. If Medicare pays only a part of this premium, we will bill you for the amount that Medicare doesn’t cover.

Premiums, copays, coinsurance, and deductibles may vary based on the level of help that beneficiaries may receive. Contact the plan for further details. Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under nonroutine circumstances, and quantity and restrictions may apply. It may cost more to get care from out–of–network providers, except in an emergency. If there isn’t a network provider available for you to see, you can go to an out–of–network provider but still pay the in–network amounts except for members who live in our Maryland service areas. Those members can only use doctors, specialists, or hospitals in–network. The health providers in our network can change at any time.