Dual Special Needs Plans

WHAT ARE DUAL SPECIAL NEEDS PLANS (D-SNPS)?

Dual Special Needs Plans or D-SNPs are a type of Medicare Advantage Plan geared toward those with a limited income and severe chronic conditions such as:

● HIV/AIDS
● Chronic heart failure
● End-Stage Renal Disease

The “Dual” part of the term refers to the requirement of qualifying for both Medicare and Medicaid.

DETERMINING ELIGIBILITY

Two factors determine eligibility:

● Qualifying for Medicare and Medicaid together.
● Medicare eligibility is that you are at least 65 years old or have received Social Security or Disability benefits for 24 months.
● Medicaid eligibility is if you earn below the Modified Adjusted Gross Income (MAGI). The qualifying MAGI varies from state to state.

D-SNP PLAN BENEFITS

D-SNPs give you all the benefits of Original Medicare, which includes coverage for hospital visits and outpatient treatments. But they are also required to offer benefits beyond this.

All D-SNPs provide benefits beyond Original Medicare, such as:

● Prescription drug coverage
● Dental
● Hearing

These programs also revolve around healthcare needs specific to your condition.

COVERAGE LIMITATIONS

● Coverage is limited to your plan’s network.
● Also, like other types of Medicare Advantage Plans, such as HMOs, you must choose a primary care doctor.
● In most cases, you will need a referral from that doctor before you can see a specialist.

WHEN TO ENROLL in a dual special needs plan

Enrolling in a D-SNP doesn’t have to be a difficult process as long as you are aware of the Medicare Enrollment Periods:

● Initial Enrollment Period: The Initial Enrollment Period is a seven-month period that starts your Medicare eligibility. It begins three months before your 65th birthday and ends three months after.

● Annual Enrollment Period: AEP begins on October 15th and ends on December 7th of every year. During this period, you have the option to make changes to your Medicare coverage, such as switching from Original Medicare to Medicare Advantage. If you’re currently enrolled in Medicare Advantage, you also have the option to switch to a different Medicare Advantage Plan.

● Special Enrollment Period: The SEP can be triggered in several ways but is ultimately unique to the individual’s situation. It is best to speak with a Medicare Specialist to determine if you qualify for a SEP. One of the most common reasons beneficiaries qualify for this period is because they moved out of their plan’s service area. If you do qualify for this period, you have the option to make changes to your Medicare Advantage Plan, or you switch back to Original Medicare.

Reach out to us today to discover if Medicare Advantage and D-SNPs are the right fit for your medical needs.