Dually Eligible

Dual eligibles are individuals who are entitled to Medicare Part A and/or Medicare Part B and are eligible for some form of Medicaid benefit.

Beneficiaries who are meet definition for dual eligibility are often medically complex and are in poorer health when compared to other Medicare and Medicaid beneficiaries. This leads to challenges in managing the cost of care for patients who are in long term care, while still providing all services that the beneficiary needs in order to remain at their best possible health status. Medicare is the primary payer for most services, but Medicaid covers benefits not offered by Medicare.

Dual eligibles typically receive their Medicare and Medicaid benefits through each program separately. Coverage rules can be complex, because beneficiaries can choose their Medicare coverage (traditional Medicare versus a Managed plan), or may choose a dual eligible special needs plan (D-SNP) to meet their needs. The Affordable Care Act (ACA) has established a new type of D-SNP that is referred to as a Fully Integrated Dual Eligible (FIDE) SNP. One of the most challenging aspects of dual eligibility is that the Medicare and Medicaid systems do not "talk" to one another, so providers may not be aware of the benefits that the patient has under one system. 

How can Kris B Harmony (KBH) help?

The Kris B Harmony (KBH) team of HealthCARE Specialist will assist your team by:

  • Helping to navigate through patient benefits
  • Providing education to key members of your team
  • Support the identification of billing that is accurate, timely, and efficient
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