Dual Special Needs Plans

If you are entitled to receive Medicare benefits and Medicaid medical assistance, you can enroll in a Dual Eligible Special Needs Plan. These plans can provide you with access to unique health care coverage, so it is important to determine whether one of these plans is right for you. Here is what you can expect from Dual Special Needs Plans (D-SNPs).

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The Difference Between Medicare and Medicaid

Medicare provides health benefits for individuals who are age 65 or older and younger people who have been diagnosed with a qualifying disability. Medicare is a federal program that is administered at the national level. Medicaid, on the other hand, is a state level program that provides health care benefits to low income individuals. While Medicare’s rules are consistent across the country, Medicaid’s rules vary from state to state.

Qualifying For Medicare and Medicaid

If you weren’t aware, it is possible to qualify for both Medicare and Medicaid at the same time. If you do qualify for both programs, you are classified as someone who is “dual eligible”. Dual eligibility can provide you with unique health care coverage options, such as Dual Special Needs Plans.

Medicare Advantage Coverage

D-SNPs are not a part of Original Medicare. They are Medicare Advantage plans offered by private insurers who have contracted with Social Security to provide you with your Part A and Part B Medicare benefits. Unlike Original Medicare plans, Medicare Advantage plans can offer a wide array of useful coverage options that vary across providers.

Additional Benefits

A D-SNP can offer dual eligible individuals access to extra benefits and features that would not be available through Original Medicare or Medicaid alone. For example, many D-SNPs offer beneficiaries access to dental, hearing, and vision coverage. You may also be able to gain access to covered rides to the doctor’s office or pharmacy. In some cases, D-SNPs can even be purchased with no monthly premiums. This makes D-SNPs an affordable option for low income seniors.

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Qualifying For D-SNPs

If you wish to enroll in a D-SNP, you must be eligible for both Medicare and Medicaid. To qualify for Medicare, you must be at least age 65 or have a qualifying disability. For people who wish to enroll due to a disability, in most cases you need to collect Social Security disability benefits for at least 24 months. If you are diagnosed with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis, you can receive Medicare benefits earlier. To qualify for Medicaid, you don’t need to be a certain age or have any disability. Instead, your income and asset level must fall into a certain range.

Types Of D-SNPs

There are several different types of D-SNPs. They are:

The All-Dual D-SNP – Available to any dual-eligible beneficiary.
Medicare Zero Cost Sharing – Available to dual-eligibles who aren’t responsible for cost-sharing for Medicare Parts A and B.
Full-Benefit D-SNP – Available to dual-eligible individuals who qualify for full Medicaid benefits for the month under any eligibility category.
Dual Eligible Subset – Available to dual-eligibles in select groups determined by the insurer and their state’s Medicaid Agency.
Dual Eligible Subset Medicare Zero Cost Sharing – Available to certain individuals who aren’t responsible for Medicare cost-sharing who fall into a certain category as determined by their insurer and their state’s Medicaid Agency.

El-Mag Insurance can help you determine whether you are dual eligible. If you are, we can also help you find a suitable D-SNP. To begin the enrollment process, call us at 954-674-1444.

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