The term “dual eligible beneficiaries” refers to the 12 million low-income seniors and children with disabilities covered by both Medicare and Medicaid. Many of whom live with substantial health needs, including chronic illness, disabilities, and mental health and social issues that can lead to higher care costs.
The CMS payment model for Medicare Advantage (MA) plans doesn’t fully cover these additional care costs if dual eligible members are not enrolled. Recent updates to the CMS reimbursement structure further incentivize MA plans to identify members in their plan populations who are either full or partial dual eligible to ensure reimbursements that accurately account for cost of care for the plan.
Identifying and enrolling dual eligible members leads to an increase in RAF by 15-25% depending on HCC conditions.
Lift in RAF score for dual eligible members enables more accurate reimbursements for your health plan from CMS.
Medicaid enrollment translates to increase access to care and resources for members, helping them stay healthier over time.
Members get increased access to resources and different types of care.
Members receive financial benefits, including Medicare premium or deductible copayment.
Members gain access to additional coverage through Medicaid such as nursing home care, personal care, or home- and community-based services.