Medicare and Medicaid: Arizona Dual Eligiblesby Denise Early on Apr. 22, 2013, under Health
Medicaid is a state/federal program providing health insurance for low-income Americans. In Arizona, Medicaid is known as the Arizona Health Care Cost Containment System (AHCCCS, pronounced “access”). People on Medicare, who have income below $950 per month, qualify for AHCCCS help. These folks are called “dual eligibles” because they have both Medicare and Medicaid/AHCCCS.
Some changes are coming in 2014 for dual eligibles, and some changes that were supposed to happen have been canceled.
Medicare Advantage plans for duals:
Many dual-eligibles are enrolled in Medicare Advantage plans that are designed to work with the AHCCCS system which pays co-pays and co-insurance. A dual-eligible person should not have any co-pays for their medical care, and their Medicare Advantage plan should co-ordinate with their AHCCCS health plan so the patient has no costs. Co-ordination is key because these Medicare Advantage plans have networks and AHCCCS health plans have networks, and the patient must use doctors that are in both plan networks. It’s kind of complicated.
Certain Medicare Advantage plans for duals will be canceled as of January 1st 2014.
In Pima County, the Health Net Amber Plan and the Abrazo Dual plan will be canceled because they will not have an AHCCCS plan, and this will be a requirement in 2014. Abrazo and Health Net will have AHCCCS health plans in Maricopa county in 2014, so their Medicare Advantage plans for duals will continue there.
In Pima County, thousands of dual-eligibles will have to change their Medicare Advantage plan. They will receive a notice from AHCCCS this summer – if AHCCCS has their correct address. Insurance agents who enrolled people in Abrazo and Amber will want to change them to another plan – if they can find them.
Arizona drops out of Dual Demonstration project
Last week, Arizona informed the federal government it is dropping plans to integrate Medicare coverage with Medicaid (AHCCCS) in 2014. The plan would have required the state to have every dual-eligible person enrolled in the same Medicare Advantage plan as their AHCCCS plan. The idea was to create one coordinated health plan that would encompass Medicare and Medicaid. It would also avoid some of the complications that come with making sure people stay in their plans’ networks so they do not incur any medical bills. Better coordination of care was also a target of this “demonstration plan”.
Cancellation of this demonstration project means no chaos for most low-income Medicare beneficiaries this fall. But for people enrolled in the Amber plan and Abrazo dual plan, they will have to make a change, or they will be moved back to Original Medicare and assigned a Part D plan – if Medicare can find them to let them know about the change.
NOTE: Dual-eligibles can change their Medicare Advantage plan or their Part D plan throughout the year.