Dual Eligible Members
Clients who are enrolled in both Medicaid and Medicare are "dual eligible" Members. Dual eligible clients must choose a STAR+PLUS health plan, but do not choose a PCP because they receive acute care services from their Medicare providers. The STAR+PLUS health plan only provides Medicaid long term support services for dual eligible Members. Prescription drugs are covered under Medicare Part D for dual eligible members.
To find out who is responsible for paying claims for dual eligible Members, select a service below.
Claims Responsibility for Acute Care Services
Select the Member’s coverage, then identify the appropriate payer for acute care services in the “Acute Care Payer” column.
|
Member's Coverage |
Acute Care Payer |
|
HealthSpring STAR+PLUS Only |
HealthSpring STAR+PLUS |
|
HealthSpring STAR+PLUS with HealthSpring Medicare |
HealthSpring Medicare |
|
Other STAR+PLUS Health Plan with HealthSpring Medicare |
HealthSpring Medicare |
|
HealthSpring STAR+PLUS with Medicare or other Medicare Health Plan |
Medicare or Member’s Medicare Health Plan |
Claims Responsibility for Long Term Support Services
Select the Member’s coverage, then identify the appropriate payer for long term support services in the “Long Term Support Services Payer” column.
|
Member's Coverage |
Long Term Support Services Payer |
|
HealthSpring STAR+PLUS Only |
HealthSpring STAR+PLUS |
|
HealthSpring STAR+PLUS with HealthSpring Medicare |
HealthSpring STAR+PLUS |
|
Other STAR+PLUS Health Plan with HealthSpring Medicare |
Member’s STAR+PLUS Health Plan |
|
HealthSpring STAR+PLUS with Medicare or other Medicare Health Plan |
HealthSpring STAR+PLUS |
Claims Responsibility for Pharmacy Services
Select the Member’s coverage, then identify the appropriate payer for pharmacy services in the “Pharmacy Payer” column.
|
Member's Coverage |
Pharmacy Payer |
|
HealthSpring STAR+PLUS Only |
Vendor Drug Program |
|
HealthSpring STAR+PLUS with HealthSpring Medicare |
HealthSpring Medicare |
|
Other STAR+PLUS Health Plan with HealthSpring Medicare |
HealthSpring Medicare |
|
HealthSpring STAR+PLUS with Medicare or other Medicare Health Plan |
Medicare or Member’s Medicare Health Plan |
Claims Responsibility for Vision Services
Select the Member’s coverage, then identify the appropriate payer for routine vision services in the “Vision Care Payer” column.
|
Member's Coverage |
Vision Care Payer |
|
HealthSpring STAR+PLUS Only |
HealthSpring STAR+PLUS
(Value Added Services are paid through OptiCare Managed Vision) |
|
HealthSpring STAR+PLUS with HealthSpring Medicare |
HealthSpring Medicare |
|
Other STAR+PLUS Health Plan with HealthSpring Medicare |
HealthSpring Medicare |
|
HealthSpring STAR+PLUS with Medicare or other Medicare Health Plan |
Medicare or Member’s Medicare Health Plan |
Claims Responsibility for Dental Services
Select the Member’s coverage, then identify the appropriate payer for dental care services in the “Dental Care Payer” column.
|
Member's Coverage |
Dental Care Payer |
|
HealthSpring STAR+PLUS Only |
HealthSpring STAR+PLUS
(Value Added Services are paid through StarDent, subject to benefit limits.) |
|
HealthSpring STAR+PLUS with HealthSpring Medicare |
HealthSpring Medicare |
|
Other STAR+PLUS Health Plan with HealthSpring Medicare |
HealthSpring Medicare |
|
HealthSpring STAR+PLUS with Medicare or other Medicare Health Plan |
Medicare or Member’s Medicare Health Plan |