Texas Health and Human Services
| |
|Prior to 3/1/2015: Who Pays Medicare Cost-Sharing for Dual Eligibles? |
|Who Pays? |Medicare Part A |Medicare Part B (through |Medicare Parts A & B provided by MAPs |
| |(through Medicare FFS) |Medicare FFS) |(through the managed care Medicare Part C |
| | | |program)* |
|STAR+PLUS MCOs |No |No |No |
|Medicare MCOs (MAPs) | | |Yes, for dual eligibles enrolled with an |
|contracted with HHSC |See Part C |See Part C |HHSC-contracted Medicare MCO |
|to cover Medicaid’s share of cost-sharing | | | |
|Medicare MCOs (MAPs) |No |No |No |
|not contracted with HHSC | | | |
|Dual Demo Medicare-Medicaid Plans (MMPs) |N/A |N/A |N/A |
|Medicaid FFS |Yes, for dual eligibles |Yes, for dual eligibles in |Yes, for dual eligibles enrolled with a |
|(Claims Administrator) |in FFS Medicare |FFS Medicare |Medicare MCO not contracted with HHSC |
| |
|Effective 3/1/2015: Who Pays Medicare Cost-Sharing for Dual Eligibles? |
|Who Pays? |Medicare Part A (through |Medicare Part B (through Medicare FFS) |Medicare Parts A & B provided by MAPs |
| |Medicare FFS) | |(through the managed care Medicare Part C |
| | | |program)* |
|STAR+PLUS MCOs |Yes, only nursing facility | No |Yes, only Part A nursing facility coinsurance|
| |coinsurance for dual eligibles | |for dual eligibles enrolled in STAR+PLUS |
| |enrolled in STAR+PLUS | | |
|Medicare MCOs (MAPs) |See Part C |See Part C |Yes, for dual eligibles who are: |
|contracted with HHSC | | |Not in STAR+PLUS or Dual Demo – Part A and |
|to cover the Medicaid’s share of | | |Part B |
|cost-sharing | | |In STAR+PLUS – Part A (except NF coinsurance)|
| | | |and Part B |
|Medicare MCOs (MAPs) |No |No |No |
|not contracted with HHSC | | | |
|Dual Demo Medicare-Medicaid Plans (MMPs) |See Part C |See Part C |Yes, for dual eligibles enrolled in the Dual |
| | | |Demo in one of the six participating counties|
|Medicaid FFS |Yes, for dual eligibles who are: |Yes, for all dual eligibles not |Yes, for dual eligibles who are: |
|(Claims Administrator) |Not in STAR+PLUS or Dual Demo – |participating in the Dual Demo. This |Not in STAR+PLUS or Dual Demo – Part A and |
| |Part A |includes those who are: |Part B |
| |In STAR+PLUS – Part A (except NF |in FFS Medicare, |In STAR+PLUS – Part A (except NF coinsurance)|
| |coinsurance) |not enrolled in STAR+PLUS, or |and Part B |
| | |enrolled in STAR+PLUS | |
* Texas Medicaid does not pay Part C premiums.
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.