Medicare Health Plans and Dual-Eligible Solutions
Promoting optimal health and improved quality of life
Individuals of all ages who qualify for both Medicaid and Medicare (dual eligible) often live with complex physical, behavioral, and social issues. They are among the nation’s most chronically ill and resource-intensive patients, and have historically received care in uncoordinated systems — which often results in poor quality of care and unnecessarily high costs for states.
AmeriHealth Caritas has developed specialized, proven solutions just for these unique people.
- Medicare Dual Eligible Special-Needs Plans (D-SNP) — for people entitled to Medicare Part A, enrolled in Medicare Part B, and receiving Medical Assistance for certain categories of aid.
- Medicare-Medicaid Plans (MMP) — for people with full benefit dual Medicare and Medicaid eligibility.
These plans serve individuals who may have cognitive disabilities, physical impairments, or debilitating chronic conditions that make independent living and self-care extremely difficult.
In addition, some dual-eligible beneficiaries qualify to receive long-term services and supports (LTSS), such as non-rehabilitative, nursing facility-level of care.
The innovative AmeriHealth Caritas approach
Our person-centered model of care meets the unique needs of the most vulnerable individuals. We address their physical health as well as the broader range of services needed for behavioral, social, and long-term support. Our approach integrates:
- Proven, established care management.
- Preventive services.
- Programs that effectively coordinate care.
- Supplemental benefits to original Medicare.
Our members have choice and control. We provide access to high quality services that promote optimal health outcomes, independence, and improved quality of life.
Caring for Caregivers
When we toured Pennsylvania to hear the needs of unpaid caregivers for the state's LTSS population, we heard about caregivers' high levels of stress and how their responsibilities impact their own health.
Reaffirming our commitment not only to our members but also to their families and the communities where they live, we put into place our Caring for Caregivers program, which includes:
- Caregiver assessment and supports plan: We assess caregiver needs, and then develop a customized plan with them to improve their capabilities and health.
- Caregiver respite and relief: Our service coordinators arrange and coordinate respite care to make sure caregivers get the break they need in daily caregiving.
- Caregiver Connections to Care: Through our technology offerings, caregivers can collect and transmit biometric data on members to our care team, so we can evaluate and act on their observations and concerns.
- Caring for Caregivers hotline: Our dedicated, around-the-clock phone line offers information and support for caregivers.