Medicare Advantage Options for Dual Eligible Beneficiaries
Some people qualify for both Medicare and Medi-Cal and are “dual eligible” or Medi Medi beneficiaries. When an individual has both Medicare Parts A and B, Medicare is the primary insurance and pays for most medical care. Medi-Cal is the secondary insurance, and it pays for costs not covered by Medicare and provides additional benefits not covered by Medicare.
Like all Medicare beneficiaries, dual eligible beneficiaries can choose whether to receive care through
Original Medicare, or enroll in a Medicare Advantage plan, sometimes called “Part C” or “MA Plans.” In California there are several types of Medicare Advantage plans, and plan options vary by county.
Some plans provide integrated care, across both Medicare and Medi-Cal benefits. The
My Care My Choice website provides information about integrated care options in each county, and local
HICAP organizations can also provide assistance.
Types of Medicare Advantage Plans
Approximately 55 percent of dually eligible beneficiaries in California are in Original Medicare. The remainder, approximately 45 percent, are enrolled in some type of Medicare Advantage. Please see the following reports for dual eligible Medicare Advantage enrollment data, by type of plan:
“Regular” Medicare Advantage Plans (for all Medicare beneficiaries)
“Regular” Medicare Advantage plans serve both dual eligible and Medicare only members and are not required to have written agreements with state Medicaid agencies, such as DHCS, for benefit and care coordination for dual eligible beneficiaries.
Medicare Medi-Cal Plans (MMPs or Medi-Medi Plans)
Medicare Medi-Cal Plans (MMPs or Medi-Medi Plans) are a type of Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) that meets integrated care coordination requirements, have integrated member materials, and have membership limited to dually eligible individuals who are also enrolled in the Medi-Cal managed care plan affiliated with the D-SNP. This aligned enrollment provides more integrated and coordinated care than other D-SNPs, where members may not be in a Medi-Cal plan that aligns with their Medicare plan. When dual eligible beneficiaries choose a Medicare plan that is an MMP, they are automatically enrolled in the Medi-Cal plan that aligns with their Medicare plan, so there is one organization coordinating care across both sets of benefits. Medi-Medi Plans is the California-specific program name for Exclusively Aligned Enrollment (EAE) D-SNPs.
Medi-Medi Plans are available in twelve counties in 2024. The list of counties and plans is available on the
MMP Outreach webpage.
Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs)
D-SNPs are a type of Medicare Advantage plan that provide specialized care and wrap-around services for dual eligible beneficiaries. Enrollment is limited to dual eligible beneficiaries with Part A and Part B Medicare. D-SNPs must have a signed State Medicaid Agency Contract (SMAC) with DHCS, which establishes care coordination and Medicare-Medi-Cal benefit coordination requirements for the plan. Based on state law, DHCS determines whether to contract with specific D-SNPs in each county.
D-SNPs that are not Medi-Medi Plans are also known as Non-EAE D-SNPs. This type of D-SNP includes plans with an affiliated Medi-Cal plan, as well as plans that do not have an affiliated Medi-Cal plan in that county. When D-SNP members are enrolled in non-affiliated Medi-Cal plans, that means the members are in two different health plans for their Medicare and Medi-Cal benefits.
Note: D-SNP “look-alike" plans are MA plans that are marketed to, and have membership consisting of, a high percent of dual eligible beneficiaries. However, D-SNP look-alike plans do not provide care coordination or wrap-around services. More information on D-SNP “look-alike" plans can be found on the
MA D-SNP Look-Alike Plans webpage.
Program of All-Inclusive Care for the Elderly (PACE):
Program of All-Inclusive Care for the Elderly (PACE): PACE covers Medicare and Medi-Cal benefits, including prescription drugs. It will coordinate healthcare, homecare, transportation, and dental care. To find out if PACE is available in your area, and to enroll, please go to the
CalPACE webpage.
SCAN Connections and Connections at Home:
SCAN Connections, and Connections at Home, is a Medicare Advantage Special Needs Plan that covers Medicare and Medi-Cal benefits, including prescription drugs, dental, healthcare, homecare, transportation, and related benefits. To find out if SCAN Connections at Home is available in your area, and to enroll, please go to SCAN Health Plan webpage.
