Dual Eligibility Frequently Asked Questions
Centauri helps Medicare Advantage members apply for and maintain Full Dual, Partial Dual, and LIS (Extra Help) benefits through targeted outreach, eligibility screening, enrollment support, and redetermination services.
Centauri pairs compassionate member engagement with industry-leading analytics to identify members most likely to benefit from dual eligibility. Our teams stay responsive to CMS and payment-model changes, ensuring plans remain aligned with evolving requirements.
Centauri has supported Medicare Advantage plans for more than three decades across the United States, in every state except Puerto Rico.
Our AI-driven analytics leverage CMS, internal, and census data to predict dual eligibility with high accuracy. The model identifies nearly 99% of dual-eligible members within the top four deciles of the non-dual population, allowing outreach to focus on those most likely to qualify. We also analyze partial-dual members to identify individuals who may qualify for full dual status.
- Analytics & Identification — Predictive modeling identifies members likely to qualify.
- Prioritized Outreach — Focus on members with the greatest medical and financial need.
- Enrollment Support — CMS-compliant outreach, education, and follow-up guide members through dual enrollment.
- SDoH Screening & Support — Screening and referrals help members access Medicaid, MSP, LIS, and other basic-needs programs.
- Retention & Recertification — Proactive outreach ensures timely recertification and prevents loss of dual status.
We use proactive outreach, multiple engagement channels, ongoing consent management, and quarterly eligibility reassessments. CMS data analysis flags members at risk of losing coverage so plans can intervene early.
Members gain increased personal income because their Medicare Part B premium is no longer deducted from their Social Security check. They also receive referrals to community assistance programs through our SDoH support.
Spend-down and eligibility rules vary significantly by state and can be highly complex. Centauri embeds these rules directly into our screening process and equips staff with detailed job aids and systems that manage thousands of requirements — ensuring accuracy that generic criteria often miss.
We assess needs, recommend resources, initiate connections, and complete warm transfers to the health plan. Common assessment areas include housing, food insecurity, transportation, financial support, safety concerns, and social isolation. Top needs among Centauri members: housing (31.9%), food (26.3%), and financial support (18.7%).
Centauri’s platform is HITRUST r2 Certified, and our reporting dashboard is updated daily and fully compliant with requirements for handling and exchanging patient information.
Dual Eligibility is one of five Member Connect offerings — alongside Disability Eligibility, Medicaid Retention, Social Services+, and Long-Term Care — all designed to help individuals access the benefits they are entitled to.