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 certain eligibility requirements of the plan.

Dual-Eligible Special Needs Plan is just one of the Medicare Advantage plans which are designed for people who meet the requirements for both Medicare and Medicaid.

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.

Special Needs Plan 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

Dual Eligible SNPs also must include Medicaid benefits in their offer or manage to provide these benefits through other options like Medicaid-managed long-term services and supports programs, Medicaid-managed care plan, or fee-for-service Medicaid. These conditions depend on your state area, so check with the insurance company first.

How Does SNP Work?

Since this type of plan combines Medicare and Medicaid benefits, it becomes easier accessible for those with lower income status, special medical conditions, and specific healthcare needs. However, Dual Eligible plans requirements can have different categories of Medicaid eligibility. These categories will determine which type of SNP-eligible individuals can choose as well as what level amount of help they will receive and what their cost-sharing amount will be.

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, Dual Eligible beneficiaries have access to doctors or hospitals that specialize in treating their chronic condition. A Chronic Special Needs plan or C- SPN is designed for people with chronic conditions or other specific disabilities like diabetes, heart disease, etc.

Unlike other Medicare Advantage plans, Special Needs plans are obligated to include prescription drug coverage. Remember that the benefits you are eligible for depending on your area and plan providers. Most Dual Eligible Special Needs plan comes with 0$ premiums or no extra cost for their beneficiaries.

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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.