Dual Eligible Special Needs Plans (D-SNP) in California

In order to be eligible for Medicare-Medicaid Dual plans you will likely have to be eligible for your State’s Medicaid program and also eligible for Medicare. Each State has different requirements and income limits to qualify for Medicaid. You may need to meet the income limit requirements for your State’s Medicaid program in order to qualify for a Medicare-Medicaid Dual Eligible plan.

Medicare and Medicaid coordinate benefits and coverage for Dual Eligible Plans. Medicare is primary and pays first for medical services, while Medicaid is secondary and may cover medical costs not covered, or partially covered, by Medicare.

There are several different types of dual eligible beneficiaries, which can determine how Medicare and Medicaid coordinate coverage:

• QMB (Qualified Medicare Beneficiary)
  • Medicaid pays premiums and cost sharing for Medicare Part A and Part B benefits
• QMB Plus (Qualified Medicare Beneficiary Plus)
  • Same as QMB, but Medicaid also pays for full Medicaid benefits
• SLMB (Specified Low-Income Medicare Beneficiary)
  • Medicaid pays for Medicare Part B premium
• SLMB Plus (Specified Low-Income Medicare Beneficiary Plus)
  • Same as SLMB, but Medicaid also pays for full Medicaid benefits
• Other FBDE (Full Benefit Dual Eligible)
  • Medicaid pays Medicare Part B premium and full Medicaid benefits
• QDWI (Qualified Disabled & Working Individual)
  • Medicaid pays Medicare Part A premium