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It is difficult to navigate through Medicare plans as there are many different types out there. However, if you are eligible for Medicare and Medicaid, the simplest option is to enroll in a Dual Eligible Special Needs Plan. Here is everything you need to know. 

What are Dual Eligible Special Needs Plans? 

A D-SNP is a Medicare Advantage plan that uses both Medicare and Medicaid, which offer affordable coverage with more benefits for qualifying people. Since D-SNPs are Medicare Advantage plans, they are required to offer everything that traditional Medicare covers at a minimum, but the benefits don’t stop there. The plan offers coordinated care teams to assist with your care such as health care provider visits or crafting a care plan with your doctor that fits your individual needs. This often includes professionals such as nurse care manager. Care coordinator, a social worker, and a member advocate to make sure your needs are heard and met. 

D-SNP benefits vary from state to state since Medicaid is a state program. With that said, many D-SNPs tend to offer the following benefits: 

  • $0 monthly premiums 
  • Over-the-counter quarterly benefits 
  • Prescription drug coverage
  • Dental, vision, and hearing benefits
  • Transportation benefits 
  • Gym memberships 
  • Telehealth services 

Who Qualifies for D-SNPs? 

Since Medicare D-SNPs rely on coverage from both Medicare and Medicaid, you need to have both in order to enroll. 

For Medicare, you must be 65 or older or meet one of the qualifying circumstances, like receiving 25 months of Social Security Disability Insurance (SSDI) or having ALS or End-Stage Renal Disease. 

For Medicaid, eligibility varies based on state, which can make figure out our your eligibility a bit difficult, but still worth exploring. 

D-SNP eligibility isn’t as straightforward as, if you’re eligible for both Medicare and Medicaid, you are allowed to enroll in a D-SNP plan. There are different categories or standards that depend on your Medicaid coverage and other factors. Depending on your circumstances, you may qualify for a Plus plan, which usually uses the eligibility criteria of having full Medicaid. 

2022 Dual Eligible Standards 

  • Full Medicaid only 
  • Qualified Medicare Beneficiary (QMB) only 
  • QMB Plus 
  • Specified Low-Income Medicare Beneficiary (SLMB) only 
  • SLMB Plus 
  • Qualifying Individual (QI) 
  • Qualified Disabled and Working Individual (QDWI) 

Enrolling in a D-SNP 

If you are interested in a D-SNP plan, enrolling is simple. You can enroll in a D-SNP anytime you would enroll in any other Medicare Part C plan. The Annual Enrollment Period (AEP) and Medicare Advantage Open Enrollment Period (MA OEP) are both options when it comes to switching to the plans. You are also granted a Special Enrollment Period (SEP) when you become dual eligible or eligible for both Medicare and Medicaid. Also, dual eligible beneficiaries are able to enroll, unenroll, or switch D-SNPSs once per each of the first three calendar quarters. This provides plenty of opportunities to figure out which plan would fit your needs the best. 

If you qualify for both Medicare and Medicaid, a D-SNP is worth exploring. Project Medicare will always be a source of information to thoroughly explain your health insurance plan and our support does not stop once you’re covered. All clients continue to have access to our team of advisors. Call us at 212-417-0441! Contact us today >>