Medicaid

Are entitled to both Medicare and Medicaid benefits — A dual-eligible Special Needs Plan (D-SNP) is a Medicare Advantage plan designed for people entitled to both Medicare and Medicaid. D-SNPs coordinate the two programs' benefits: Medicare pays first, and Medicaid may cover the beneficiary's cost sharing, including premiums, deductibles, and copayments, depending on the beneficiary's Medicaid share of cost. The plan may offer extra benefits tailored to dual-eligible members. D-SNPs are one of three SNP types, the others being chronic-condition and institutional SNPs, and the coordinated benefits help prevent gaps between Medicare and Medicaid while simplifying provider billing.

National insurance concept

Expanding access to affordable health coverage and strengthening consumer protections — The PPACA was enacted to expand access to affordable health coverage, broaden consumer protections, and reduce the number of uninsured. Key mechanisms include guaranteed issue, prohibitions on pre-existing condition exclusions, premium tax credits and cost-sharing reductions for lower-income households, essential health benefits, and the establishment of state exchanges such as Covered California. The California A&H objectives test the legislative purpose of the ACA directly.

National insurance concept