Determine Medicare & Medicaid Eligibility

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Checking Medicare & Medicaid Eligibility via SunFire and Carrier Portals

Need more information on the new HIDE/FIDE rules? Visit our Compliance or Training pages.

Looking Up Medicare & Medicaid Eligibility via SunFire

Sunfire provides Medicaid eligibility and provider lookups utilizing MBI and SSN in their customer profile tool. See the steps below for utilizing the lookup:

Additional Medicaid and SNP Plan Features

Customer Look-up Alert: Medicaid Eligibility Notification will appear if Customer Lookup is completed, and an Alert will show that a member’s current plan is an INT-SEP eligible plan.
Plan Indicator & Filter: Added a SEP-INT indicator on applicable HIDE/FIDE D-SNPs as well as broken out D-SNP/C-SNP plan filters within the SNP category. Automated filtering will occur when the Medicaid level is known to show which Dual-Eligible Special Needs Plans (DSNPs) the member is eligible for.
Medicaid MCO Prefill: This will show agents a member's current Medicaid Managed Care Organization (MCO) when a Medicaid lookup is completed.

For states where we have this functionality available: Agents will see what Medicaid MCO the beneficiary is assigned to and it will filter available plans.
For all other states or if MCO is not returned: We will provide agents with a dropdown to add the current Medicaid MCO so the platform can filter D-SNP plans accordingly.

State Functionality Release Dates

Live Today (27 states):

Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Indiana, Iowa, Kentucky, West Virginia, Louisiana, Maine, Michigan, Missouri, Montana, Nebraska, Nevada, New York, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Washington

As of 5/1/2025 (9 States):

Delaware, Kansas, Maryland, Mississippi, North Carolina, New Jersey, South Dakota, Virginia

Coming Summer 2025 (15 states):

Alaska, Arizona, Hawaii, Idaho, Illinois, Massachusetts, Minnesota, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Vermont, Wisconsin, Wyoming

Looking Up Medicaid Eligibility via Carrier Portals

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Aetna (Think Agent)

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Humana (Vantage)

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UHC (Jarvis)

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Cigna (Cigna for Brokers)

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Molina

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Anthem (mProducer)

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Devoted

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Checking Medicare & Medicaid Eligibility via SunFire and Carrier Portals
Looking Up Medicare & Medicaid Eligibility via SunFire
Additional Medicaid and SNP Plan Features
State Functionality Release Dates
Looking Up Medicaid Eligibility via Carrier Portals

Looking Up Medicare & Medicaid Eligibility via SunFire

Sunfire provides Medicaid eligibility and provider lookups utilizing MBI and SSN in their customer profile tool. See the steps below for utilizing the lookup:

Additional Medicaid and SNP Plan Features

Customer Look-up Alert: Medicaid Eligibility Notification will appear if Customer Lookup is completed, and an Alert will show that a member’s current plan is an INT-SEP eligible plan.

Plan Indicator & Filter: Added a SEP-INT indicator on applicable HIDE/FIDE D-SNPs as well as broken out D-SNP/C-SNP plan filters within the SNP category. Automated filtering will occur when the Medicaid level is known to show which Dual-Eligible Special Needs Plans (DSNPs) the member is eligible for.

Medicaid MCO Prefill: This will show agents a member's current Medicaid Managed Care Organization (MCO) when a Medicaid lookup is completed.

For states where we have this functionality available: Agents will see what Medicaid MCO the beneficiary is assigned to and it will filter available plans.
For all other states or if MCO is not returned: We will provide agents with a dropdown to add the current Medicaid MCO so the platform can filter D-SNP plans accordingly.

State Functionality Release Dates

Live Today (27 states):

Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Indiana, Iowa, Kentucky, West Virginia, Louisiana, Maine, Michigan, Missouri, Montana, Nebraska, Nevada, New York, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Washington

As of 5/1/2025 (9 States):

Delaware, Kansas, Maryland, Mississippi, North Carolina, New Jersey, South Dakota, Virginia

Coming Summer 2025 (15 states):

Alaska, Arizona, Hawaii, Idaho, Illinois, Massachusetts, Minnesota, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Vermont, Wisconsin, Wyoming