If you’re eligible for both Medicare and Medicaid, this means you are “dual eligible” and may qualify to enroll in a Dual Eligible Special Needs plan (D-SNP). A D-SNP is a type of Medicare Advantage plan that is offered by private health insurance companies – they can be Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plan types.
Let’s take a look at the D-SNP basics, including common advantages and how to tell if you’re eligible.
How D-SNPs work
D-SNPs have a contract with your state Medicaid program and the Centers for Medicare and Medicaid Services to offer coverage to those who are eligible for both Medicare (Parts A and B) and Medicaid benefits.
Some D-SNPs, like Minnesota Senior Health Options (MSHO), combine coverage for both programs under a single plan designed to coordinate coverage and integrate care, so things are easier for you to manage. This means only one insurance card to show at your doctor’s office, making things simple and straightforward.
All D-SNP members have access to a care coordinator who helps with navigating their dual coverage plan. These support professionals work with you to set health care goals and ensure you have access to the services you need.
D-SNP advantages and benefits
D-SNPs are different than other types of Medicare Advantage plans because they serve beneficiaries who are dual eligible for both Medicare and Medicaid. Key advantages for enrollees include the low cost of coverage, ease of reaching support or simpler care coordination and additional plan benefits. Here’s what you need to know.
Low-cost coverage
Dual eligible enrollees have options to get help paying for premiums and cost-sharing amounts like deductibles, copays and coinsurance. You may have to continue to pay Medicare’s Part B monthly premium, and you might have a separate D-SNP plan premium – however, that’s typically more affordable. Although the premium varies by plan, many D-SNPs offer subsidized premiums, which means you will most likely have a $0 or low-cost monthly premium.
Convenience and care coordination
When you’re enrolled in two types of coverage such as Original Medicare and Medicaid, things can get a little tricky. How do you know which type of coverage pays for what? There are key differences between Medicare and Medicaid coverage. And sometimes Medicaid enrollees who are 65 and older don’t know they are eligible for Medicare.
D-SNP enrollees have access to a care coordinator, which is a requirement for all special needs plans. A care coordinator can help you manage your care by developing a plan with you, coordinating your benefits and answering your questions.
Additional benefits and support
Dual Eligible Special Needs Plans may offer additional benefits that Medicare or Medicaid coverage alone does not. Exact benefits change depending on plan, but they can include assistance with or coverage of:
- Medical
- Dental
- Long-term care
- Home and community-based services
- Hearing and vision services
- Telehealth services
- Preventive care measures
- Transportation needs
- Medical equipment
Who qualifies for a D-SNP?
A Dual Eligible Special Needs plan can be a great option for those in need of extra support – especially for people who want to enroll in Medicare and keep Medicaid coverage after turning age 65 and those from low-income households or living with chronic health conditions or disabilities. If you’re interested in enrolling in a D-SNP, you must be eligible for both Medicare and Medicaid.
To qualify for Medicare, you must be:
- An American citizen or someone lawfully present in the U.S.
- 65 years or older
- Under 65 with specific disabilities
- A past contributor to Social Security for a minimum of 10 years
Medicaid eligibility can be a little more complex. Each state has its own rules in place to assess who does and does not qualify. In most cases, a combination of factors can contribute, such as income, age, housing situation, household size or disability. For instance, in Minnesota, Medical Assistance eligibility is based on specific income and resource guidelines.
How to choose a D-SNP: Things to consider
When you’re shopping around for a Dual Eligible Special Needs plan, look at what kind of coverage and benefits will support your unique health needs the best. Do you have a chronic condition? How frequently do you visit the doctor? What kind of medications are you taking? These are considerations that will help you make the best choice.
Check the plan’s network
When you’ve established a long-time relationship with a trusted doctor, it can be hard to even think about switching to a new provider. Check to ensure your current providers are in your prospective plan’s network. You can do this by looking up your D-SNP’s provider network online or by calling your doctor’s office to see if they accept the plan.
Consider extra benefits
As mentioned, many D-SNPs offer extra perks and benefits that can help support your health goals. For instance, some D-SNP plans may offer an allowance for over-the-counter items, or they can provide coverage for additional dental, hearing and vision services not already covered by Medicaid or Medicare.
Make sure prescriptions are covered
We all know how quickly the costs of prescription drugs can add up. All Dual Eligible Special Needs plans are required to include Medicare Part D prescription drug coverage. However, each plan has an individual formulary, also known as a drug list. Make sure to review your D-SNP’s prescription drug formulary to confirm your medications are covered.
Check your Medicaid eligibility
Medicaid offers different levels of coverage depending on your eligibility, and each state measures beneficiaries’ needs based on specific rules. This means you could receive full coverage or limited coverage from Medicaid depending on how the state assesses your needs. When shopping for a D-SNP, make sure your level of Medicaid qualifies for that specific plan.
Is a Dual Eligible Special Needs plan right for you?
There are plenty of reasons why a Medicare-Medicaid enrollee might benefit from a D-SNP. Medicaid itself is a great program, but sometimes its coverage may not be enough. A dual eligible plan can offer Medicare coverage alongside Medicaid and often with extra benefits at an affordable price – so you can get the care you need.
Learn about MSHO
Our experts are here to help you find the best Medicare plan for the way you live. Learn more about Minnesota Senior Health Options.