A two-minute guide to Medicare Dual-Eligible Special Needs Plans

Navigating the world of health insurance can be challenging, especially if you’re eligible for both Medicare and Medicaid. Medicare has special plans for people who qualify for both Medicare and Medicaid.

These plans meet the unique needs of dual-eligible individuals. These plans, called Dual-Eligible Special Needs Plans, or D-SNPs, can provide additional benefits, cost savings, and simplified care coordination. Here’s what you need to know about D-SNPs and how they could be the right solution for you.

What is a Dual-Eligible Special Needs Plan (D-SNP)?

A Medicare Dual-Eligible Special Needs Plan is a type of Medicare Advantage plan tailored specifically for people who qualify for both Medicare and Medicaid. D-SNPs are designed to help bridge the gaps between these two programs, offering extra benefits beyond Original Medicare (Part A hospital insurance and Part B medical insurance). With a D-SNP, you’ll still have Medicare coverage for hospital and medical services, but with added benefits that cater to the unique needs of dual-eligible individuals.

Key benefits of D-SNPs

1. Lower out-of-pocket costs: D-SNPs help Medicare and Medicaid work together. This often means low or no monthly premiums, copayments, and deductibles. Because of this, you may not owe anything out-of-pocket when seeing a doctor or having tests done.
2. Comprehensive care coordination: D-SNPs often offer care coordinators. They can help you manage your health needs, schedule appointments, and understand your benefits. This increased support can help manage any chronic conditions.
3. Additional benefits: D-SNPs often offer benefits that Original Medicare does not cover. These include dental, vision, hearing, and wellness programs. Some plans even offer transportation assistance to medical appointments and allowances for over-the-counter items.
4. Simplified coverage: A D-SNP lets you manage all your healthcare needs with one plan. Your Medicare Part A coverage, Medicare Part B coverage, and Medicare Part D prescription drug coverage are all baked into one plan. This can make paperwork and billing easier. It also helps ensure you get the right level of care.
5. Prior Authorizations can't be revoked: Some medical services to treat your needs may need prior authorization from the carrier. However, these prior authorizations cannot be taken away until you complete the specific treatment.

Who qualifies for a D-SNP?

To enroll in a D-SNP, you must be eligible for both Medicare and Medicaid. To qualify for Medicaid, you need to meet certain income and asset requirements. It’s important to check with your state’s Medicaid office if you are unsure about your eligibility.

You may also qualify for various Medicare Savings Programs that can help pay your costs. Your enrollment in these programs often determines D-SNP eligibility.

Some D-SNPs only allow Full-Benefit Dual Eligibles (FBDE) to sign up. Others may only allow Qualified Medicare Beneficiaries (QMB) to join. Others may expand their criteria to include those categories, Specified Low-Income Medicare Beneficiaries (SLMB), and/or other programs. We should note -- qualifying for one of these programs may also qualify you for Extra Help with your prescription drug costs.

Each plan also has a defined service area. You must live within that service area to be eligible.

Check with the plans you are interested in to see whether you qualify. We can also help with this process.

Things to consider when choosing a D-SNP

When selecting a D-SNP, here are a few things to keep in mind:

• Provider Network: Like other Medicare Advantage plans, D-SNPs have a provider network. Make sure your preferred doctors and healthcare providers are part of the plan’s network.
• Prescription Drug Coverage: Make sure your prescription drugs are covered by the plan's formulary.
• Additional Services: Evaluate the extra benefits and support services to ensure the plan meets your unique needs.
• Customer Service and Care Coordination: Choose a plan known for great customer support and care coordination services.

Find coverage that's right for you

Choosing the right plan can be a complex process, but our agency is here to help. Our skilled agents know all about Medicare, Medicaid, and D-SNPs. They are ready to help you at every step. Whether you need more information about plan options or help with enrollment, we’re just a phone call away.