Dual Eligibles

​What Is The Difference Between Medicare And Medicaid?

​Medicare – is a federal program that provides health insurance coverage to people who have disabilities,    are diagnosed with certain medical conditions, or are the age of 65 or older. 
        ~ Medicare has three basic coverages: Part A, Part B, and Part D. 
             ○ Part A pays for hospitalization costs
             ○ Part B pays for physician services, lab and x-ray services, durable                                                                               medical equipment, outpatient, and other services.                                                                                                      ○ Part D provides coverage of prescription drug costs. 

 Because Medicare is run by the federal government, its coverage, rules and                                                     regulations are basically the  same everywhere in the United States. The                                                                   program is run by the Centers for Medicare & Medicaid  Services.

​Medicaid – is funded jointly by the federal government and the states, and                                                     provides health care coverage to low-income people who meet specific                                                             requirements for income and other eligibility criteria. Medicaid covers                                                             individuals who cannot otherwise afford insurance.

What Does This Mean for The Skilled Nursing Facilities?

  • FFS to Managed Care for Medi/Medi population
  • Managed Care Contracts needed by ancillary providers for CFAD awarded areas
  • Facility managing Managed Care - Case Management of patient stay
  • Managed Care billing perfected

What is the Financial Alignment Demonstration (FAD)?

The Financial Alignment Demonstration project is to transition dual eligible Medicare-Medicaid patients into managed care. It is a 3 year pilot program, an initiative that brings cost savings for Federal and State governments.  Is your state participating in the FAD?  What is the current status? Check here.

What are Dual Eligibles?

      Dual Eligibles Patients that qualify for both Medicare Part A and/or Part B              and are eligible for Medicaid benefits (Also known as Medi-Medis or Duals).                   ~ This went into effect on September 1, 2013.

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