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20.8.3 – Eligibility for Medicare Medical Savings Account (MSA) Plans 42 CFR §§ 422.50, 422.56, and 422.104

An individual is not eligible to elect a Medicare MSA plan if any one of the following applies:

• The individual will reside in the United States for fewer than 183 calendar days during the year in which the enrollment request is effective;

• The individual is enrolled in the Federal Employees Health Benefits (FEHB) program, or is eligible for health care benefits through the Department of Veterans Affairs or the Department of Defense;

• The individual is dual eligible and is entitled to coverage of Medicare premium and/or cost-sharing under a Medicaid State plan;

• The individual is receiving hospice benefits under the Medicare benefit prior to completing the enrollment request; or

• The individual receives health benefits that cover all or part of the annual Medicare MSA deductible, such as through primary health care coverage other than Medicare, supplemental insurance policies not specifically permitted under 42 CFR § 422.104, or retirement health benefits.

20.8.4 – Eligibility for Enrollment in MA Special Needs Plans (SNP) 42 CFR §§ 422.2, 422.50, 422.52, and 422.514(h)

An MA Special Needs Plan (SNP) must limit enrollment to individuals who also meet the specified eligibility requirements per 42 CFR §§ 422.2, 422.52, and 422.514(h) (as applicable). Additional guidance is outlined in Chapter 16-B of the Medicare Managed Care Manual. For more information on an SEP following loss of SNP status, see § 30.6.13.

Dual-Eligible SNP: A D-SNP may be required by the state Medicaid agency for the service area(s) covered by the D- SNP, through the contract required under 42 CFR § 422.107, to limit enrollment to specific eligibility groups for Medicaid. Before processing an enrollment into a D-SNP, the D-SNP must confirm both MA eligibility and Medicaid eligibility. For current enrollees, the D-SNP must verify continuing eligibility (e.g., full or partial dual status, as applicable) of enrollees at least as often as the state Medicaid agency conducts redeterminations of Medicaid eligibility.

Acceptable proof of Medicaid eligibility include: • Current Medicaid card; • Letter from the state agency that confirms entitlement to Medical Assistance; or • Verification through a systems query to a state eligibility data system.

An individual’s current eligibility for the Medicare Part D Low Income Subsidy (LIS) or any other Medicaid status flag in CMS systems are not acceptable for initial or ongoing Medicaid