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Medicare Advantage Dual-Eligible Special Needs Plans

Medicare Advantage Special Needs plans are a group of Medicare Advantage plans that support individuals with unique needs. To be eligible, you have to be enrolled in Original Medicare and meet the certain eligibility requirements of the plan. 

A Dual-Eligible Special Needs Plan is for people who have both Medicare and Medicaid benefits.

If you think you qualify for a Dual-Eligible Special Needs plan and want to confirm your eligibility, contact Turning 65 Solutions. We can affirm your eligibility and give you a fast and free quote.

Medicare Advantage Benefits

Medicare requires MA Special Needs Plans to provide the same benefits as Parts A and B. These benefits are:

  • Surgery
  • Lab tests
  • Hospice care
  • Outpatient care
  • Home health care
  • Medical equipment
  • Inpatient hospital care
  • Skilled nursing facility care
  • And some preventative services

But Advantage plans can offer additional benefits, such as:

  • Nutrition programs
  • Fitness memberships
  • Over-the-counter drugs
  • Adult day-care services
  • Dental, Hearing, and Vision
  • Transportation to doctor visits
  • And more

Some special needs plans also include care-coordination services unique to your chronic condition. Wellness plans, for example, help you stick to your special diet or other activities that are designed to improve or manage your condition. Also, you may have access to doctors or hospitals that specialize in treating your chronic condition. 

Unlike other Medicare Advantage plans, Special Needs plans are obligated to include prescription drug coverage. Remember that the benefits you are eligible for depends on your area and plan providers.

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When You Can Enroll

If you are eligible for Medicare, then you are eligible for a Medicare Advantage plan. But there are certain times in which you can enroll:

Initial Coverage Election Period (ICEP)

ICEP is a seven-month period that is your first opportunity to choose a Medicare health plan. It starts three months before the month you turn 65 and ends three months after the month you turn 65. If you are under 65 and you receive Social Security disability, you are eligible for Medicare in the 25th month after you begin receiving your Social Security benefits.  

Annual Election Period (AEP)

Also known as open enrollment, the AEP is October 15 through December 7 each year. Once January hits, coverage for your selected Medicare Advantage plan will begin. During this time, you may also add, change, or drop current coverage.   

Medicare Advantage Open Enrollment Period

During this period, you can switch from one Medicare Advantage plan to another. Or, you can end it to return to Original Medicare. 

Special Election Period

Many factors can stimulate a special election period and they are unique to an individual. It’s best to speak with a licensed Medicare insurance agent to find out whether you qualify for a special election period. However, there are a few common situations, like if you move outside your Advantage plan’s service area, move into a nursing home, or qualify for additional aid, you could be eligible for this special election period. You can institute changes to your Medicare Advantage plan during this period or go back to Original Medicare.

We Can Help

If you have questions about Dual-Eligible Special Needs plans or you would like a quote, we can help. Call our Texas office at 830-217-6711.

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