Dual Elibility Star+Plus

Bravo Health STAR+PLUS?
Who is Eligible for STAR+PLUS?
- Dual Eligible Members
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Dual Eligible Members

Clients who are enrolled in both Medicaid and Medicare are "dual eligible" Members. Dual eligible clients must choose a STAR+PLUS HMO, but do not choose a PCP because they receive acute care services from their Medicare Providers. The STAR+PLUS HMO covers only LTSS 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.

Acute care
LTSS
Pharmacy
Vision
Dental
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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
Bravo Health STAR+PLUS Only	Bravo Health STAR+PLUS
Bravo Health STAR+PLUS with Bravo Health Medicare	Bravo Health Medicare
Other STAR+PLUS Health Plan with Bravo Health Medicare	Bravo Health Medicare
Bravo Health STAR+PLUS with Medicare or other Medicare Health Plan	Medicare or Member’s Medicare Health Plan

Claims Responsibility for LTSS

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

Member's Coverage	LTSS Payer
Bravo Health STAR+PLUS Only	Bravo Health STAR+PLUS
Bravo Health STAR+PLUS with Bravo Health Medicare	Bravo Health STAR+PLUS
Other STAR+PLUS Health Plan with Bravo Health Medicare	Member’s STAR+PLUS Health Plan
Bravo Health STAR+PLUS with Medicare or other Medicare Health Plan	Bravo Health 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
Bravo Health STAR+PLUS Only	Vendor Drug Program
Bravo Health STAR+PLUS with Bravo Health Medicare	Bravo Health Medicare
Other STAR+PLUS Health Plan with Bravo Health Medicare	Bravo Health Medicare
Bravo Health 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
Bravo Health STAR+PLUS Only	Bravo Health STAR+PLUS (Value Added Services are paid through OptiCare Managed Vision)
Bravo Health STAR+PLUS with Bravo Health Medicare	Bravo Health Medicare
Other STAR+PLUS Health Plan with Bravo Health Medicare	Bravo Health Medicare
Bravo Health 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.