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Dual Plus Basics (HMO D-SNP)

Dual Eligible Special Needs Plan (SNP) for people who have both Medicare and Medicaid. How much Medicaid covers depends on your income, resources and other factors. Some people get full Medicaid benefits. Some only get help to pay for certain Medicare costs, which may include premiums, deductibles, coinsurance, or copays.


Dual Plus Benefits

Dental Coverage
$2,000 in dental services annually.

No-cost Gym Membership
SilverSneakers® fitness membership and locations nationwide at no additional cost.

Over-the-Counter (OTC)
Benefit Card, Catalog or Online Ordering Benefit $1,020 in annual credits every year for health-related items.

Hearing Aid Allowance
$2,000 allowance every two years for hearing aids and $0 hearing screening.

Transportation Benefit
36 one-way rides annually or 18 round trips to your doctor, dentist or pharmacy.

Acupuncture Benefit
12 visits per year.

Chiropractic Benefit
25 routine visits per year.

Vision Benefit
$275 annual benefit for exam, contacts and glasses.


Eligibility

To enroll in Presbyterian Dual Plus (HMO D-SNP):

  • You must be entitled to Medicare Part A and enrolled in Medicare Part B.
    Learn more about Medicare
  • You must live in one of these New Mexico counties: Bernalillo, Cibola, Colfax, Dona Ana, Grant, Luna, Otero, Rio Arriba, Sandoval, San Miguel, Santa Fe, Sierra, Socorro, Torrance or Valencia.
  • You must be in one of these Medicaid categories:
    • Qualified Medicare Beneficiary Plus (QMB+): You get Medicaid coverage of Medicare cost-share and are also eligible for full Medicaid benefits. Medicaid pays your Part A and Part B premiums, deductibles, coinsurance and copayment amounts. You pay nothing, except for Part D prescription drug copays.
    • Qualified Medicare Beneficiary (QMB): You get Medicaid coverage of Medicare cost-share but are not eligible for full Medicaid benefits. Medicaid pays your Part A and Part B premiums, deductibles, coinsurance and copayments amounts only. You pay nothing, except for Part D prescription drug copays.
    • Qualified Disabled and Working Individual (QDWI): Medicaid pays your Part A premium only. The State Medicaid Office does not pay your cost-share. You do not have full Medicaid benefits. There may be some services that do not have a member cost share amount.
    • Qualifying Individual (QI): Medicaid pays your part B premium only. The State Medicaid Office does not pay your cost-share. You do not have full Medicaid benefits. There may be some services that do not have a member cost-share amount.
    • Specified Low-Income Medicare Beneficiary (SLMB+): Medicaid pays your Part B premium and provides full Medicaid benefits. You are eligible for full Medicaid benefits. At times you may also be eligible for limited assistance from your state Medicaid agency in paying your Medicare cost-share amounts. Generally, your cost share is 0% when the service is covered by both Medicare and Medicaid. There may be cases where you must pay cost sharing when a service or benefit is not covered by Medicaid.
    • Specified Low-Income Medicare Beneficiary (SLMB): Medicaid pays your Part B premium only. The State Medicaid Office does not pay your cost-share. You do not have full Medicaid benefits. There may be some services that do not have a member cost-share amount.
    • Full Benefits Dual Eligible (FBDE): Medicaid may provide limited assistance with Medicare cost-sharing. Medicaid also provides full Medicaid benefits. You are eligible for full Medicaid benefits. At times you may also be eligible for limited assistance from the State Medicaid Office in paying your Medicare cost-share amounts. Generally, your cost-share is 0% when the service is covered by both Medicare and Medicaid. There may be cases where you have to pay cost-sharing when a service or benefit is not covered by Medicaid.

Last Updated: 10/01/2019