HealthPlus of Michigan offers a Dual Eligible Special Needs Plan (D-SNP), called MedicarePlus Advantage D-SNP. Members enrolled in this product will have dual health care coverage through Medicare and Medicaid.
Advantage D-SNP is available to beneficiaries who are eligible for Medicare and enrolled in Medicaid.
Eligible members must be enrolled in Medicare Part A and Part B.
Members can be enrolled in Fee-for-Service Medicaid, but cannot be enrolled in any other health plan’s Medicaid plan.
Benefits packages cover:
- Medicare Part A (hospital)
- Medicare Part B (medical/outpatient hospital and additional preventive care)
- Medicare Part D (outpatient prescription drugs)
The MedicarePlus Advantage D-SNP Benefit Level Summary outlines benefits and member co-pay amounts.
All MedicarePlus Advantage D-SNP members are issued a HealthPlus MedicarePlus Advantage D-SNP Member Identification Card.
MedicarePlus Advantage D-SNP offers members:
- An Integrated Care Team (ICT) that includes a personal case manager who will support the member with coordination of care and complex case management needs
- A primary care physician (PCP) who will coordinate all health care needs
- An annual health risk assessment
- Transportation services
- Coverage for preventive and routine medical
- Specialty care (referrals may be required)
- Lab services (JVHL or Quest Diagnostics laboratories)
- Hearing coverage
- Ask for 90 Rx allows a 90 day supply, to save time and money on maintenance prescription drugs.
- Worldwide emergency services coverage
- Access to wellness programs offered by HealthPlus and associated providers.
- Access to HealthPlus Disease Management programs for management of asthma, COPD, diabetes, and heart disease.
- Complex Case Management for members who are seriously ill or have complex medical needs.
- Discounts for membership in designated fitness clubs, weight loss programs and other programs through the HealthPlus HealthQuest Perks Program
- Coordination between Medicare and Medicaid
If specialty care is needed, the PCP will refer the member to the appropriate in-plan physician or appropriate medical professional. Referrals are not necessary for routine gynecological and obstetric care.
Copays and Coinsurance
D-SNP members are not liable for copays/coinsurance for covered medical services. Due to the dual coverage provided through the product, Medicare will act as the primary payer, and Medicaid will be secondary. Providers must not seek additional reimbursement from a D-SNP member.
In the event that a provider has a concern regarding the reimbursement of services, he/she must contact the State of Michigan Department of Community Health or HealthPlus of Michigan.
For questions related to a MedicarePlus Advantage HMO/POS member, please contact HealthPlus Customer Service at (800) 332-9161 and ask to speak with MedicarePlus Advantage Services.