Managing Dually Enrolled Members

Date: 10/16/25

Managing Dually Enrolled Members

Member experience can be impacted if members have a misunderstanding of their Marketplace coverage or if they have confusion on dual enrollment with Marketplace and other programs such as Medicaid or CHP. Arizona Complete Health-Complete Care Plan and Ambetter from Arizona Complete Health would like to provide guidance to providers on how to manage members who may be dually enrolled with both Medicaid and Marketplace.

Why Does this Matter?

·        Members may face loss of subsidies or repayment of tax credits.

·        Coverage disruptions create gaps in care access.

·        Confusion often leads to complaints or delayed treatment

What Can Providers Look for to Identify Dually Enrolled Members?

·        Members presenting both Medicaid and Marketplace ID cards.

·        Conflicting coverage information in billing or EHR.

What is Your Role as a Provider?

·        Ask the member if they have received dual enrollment letters.

·        Verify and document insurance details at each visit.

·        Encourage members to act quickly on notices (30-day window).

Key Talking Points You May Use:

·        “I see both Medicaid and Marketplace listed for you. Let’s confirm your primary coverage.”

·        “If you got a letter about losing Marketplace help, you need to respond within 30 days.”

·        “You can keep a Marketplace plan, but without subsidies, it will be full price.”

·        “If you think you were enrolled without consent, contact the Marketplace right away.”

If you have any questions, please reach out to Arizona Complete Health-Complete Care Plan Member Services at 1-888-788-4408 (TTY/TDD 711) or Ambetter Member Services at 1-844-428-3421 (TTY/TDD 711).