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. D-SNPs have a contract with your state Medicaid program to help coordinate your Medicare and Medicaid benefits.
Let’s take a look at the D-SNP basics, including common advantages and how to tell if you’re eligible.
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.
Dual eligible enrollees have options to get help paying for premiums, 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 your monthly payment may have no or a low cost.
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 and how to coordinate your care? 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:
- 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, such as people from a low-income household or people 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 have to 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.
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 plan. 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.
Our experts are here to help you find the best Medicare plan for the way you live. HealthPartners offers a dual eligible special needs plan for Medicare and Medicaid enrollees called Minnesota Senior Health Options (MSHO).