Dual Eligible Members

Clients who are enrolled in both Medicaid and Medicare are "dual eligible" Members. Dual eligible clients must choose a STAR+PLUS health plan, but do not choose a PCP because they receive acute care services from their Medicare providers. The STAR+PLUS health plan only provides Medicaid long term support services for dual eligible Members. Prescription drugs are covered under Medicare Part D for dual eligible members.


To find out who is responsible for paying claims for dual eligible Members, select a service below.

 

Claims Responsibility for Acute Care Services

Select the Member’s coverage, then identify the appropriate payer for acute care services in the “Acute Care Payer” column.

Member's Coverage

Acute Care Payer

Cigna-HealthSpring STAR+PLUS Only

Cigna-HealthSpring STAR+PLUS

Cigna-HealthSpring STAR+PLUS with Cigna-HealthSpring Medicare

Cigna-HealthSpring Medicare

Other STAR+PLUS Health Plan with Cigna-HealthSpring Medicare

Cigna-HealthSpring Medicare

Cigna-HealthSpring STAR+PLUS with Medicare or other Medicare Health Plan

Medicare or Member’s Medicare Health Plan

 

Claims Responsibility for Long Term Support Services

Select the Member’s coverage, then identify the appropriate payer for long term support services in the “Long Term Support Services Payer” column.

Member's Coverage

Long Term Support Services Payer

Cigna-HealthSpring STAR+PLUS Only

Cigna-HealthSpring STAR+PLUS

Cigna-HealthSpring STAR+PLUS with HealthSpring Medicare

Cigna-HealthSpring STAR+PLUS

Other STAR+PLUS Health Plan with HealthSpring Medicare

Member’s STAR+PLUS Health Plan

Cigna-HealthSpring STAR+PLUS with Medicare or other Medicare Health Plan

Cigna-HealthSpring STAR+PLUS

 

Claims Responsibility for Pharmacy Services

Select the Member’s coverage, then identify the appropriate payer for pharmacy services in the “Pharmacy Payer” column.

Member's Coverage

Pharmacy Payer

Cigna-HealthSpring STAR+PLUS Only

Vendor Drug Program

Cigna-HealthSpring STAR+PLUS with Cigna-HealthSpring
Medicare

Cigna-HealthSpring Medicare

Other STAR+PLUS Health Plan with Cigna-HealthSpring Medicare

Cigna-HealthSpring Medicare

Cigna-HealthSpring STAR+PLUS with Medicare or other Medicare Health Plan

Medicare or Member’s Medicare Health Plan

 

Claims Responsibility for Vision Services

Select the Member’s coverage, then identify the appropriate payer for routine vision services in the “Vision Care Payer” column.

Member's Coverage

Vision Care Payer

Cigna-HealthSpring STAR+PLUS Only

Cigna-HealthSpring STAR+PLUS
(Value Added Services are paid through Superior Vision Managed Vision)

Cigna-HealthSpring STAR+PLUS with Cigna-HealthSpring Medicare

Cigna-HealthSpring Medicare

Other STAR+PLUS Health Plan with Cigna-HealthSpring Medicare

Cigna-HealthSpring Medicare

Cigna-HealthSpring STAR+PLUS with Medicare or other Medicare Health Plan

Medicare or Member’s Medicare Health Plan

 

Claims Responsibility for Dental Services

Select the Member’s coverage, then identify the appropriate payer for dental care services in the “Dental Care Payer” column.

Member's Coverage

Dental Care Payer

Cigna-HealthSpring STAR+PLUS Only

Cigna-HealthSpring STAR+PLUS
(Value Added Services are paid through DentaQuest, subject to benefit limits.)

Cigna-HealthSpring STAR+PLUS with Cigna-HealthSpring
Medicare

Cigna-HealthSpring Medicare

Other STAR+PLUS Health Plan with Cigna-HealthSpring
Medicare

Cigna-HealthSpring Medicare

Cigna-HealthSpring STAR+PLUS with Medicare
or other Medicare Health Plan

Medicare or Member’s Medicare Health Plan