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Old lady discussing Special Needs Plan with her doctor

What is a Dual-Eligible Special Needs Plan?

If you have certain health conditions or are over 65 and have limited finances to pay for your medical care, you may fall into a select group that qualifies for public health insurance programs. About 12 million people qualify for both Medicaid and Medicare coverage based on their health conditions and age.

These people are eligible to have both Medicaid and Medicare, which is considered dual-eligible. They also qualify to sign up in a special type of Medicare Advantage (Medicare Part C) plan called Dual-Eligible Special Needs Plan (D-SNP).

What is the Dual-Eligible Special Needs Plan (D-SNP)?

Special Needs Plan (SNP) is a type of Medicare Part C plan that offers the same type of Original Medicare coverage. These private health insurance plans can help you coordinate care and benefits between Medicare and Medicaid. D-SNPs are the most intricate categories of the SNPs, both in terms of eligibility requirements and coverage. But the plans provide the most comprehensive benefits for those with the highest level of medical needs, with low income and resources.

What Does a Dual-Eligible Special Needs Plans Cover?

Like any other Medicare Advantage plan, D-SNP includes coverage for Original Medicare (Part A and Part B). The plan will also include Medicare Part D prescription drug coverage and extra benefits not offered by either Medicaid or Original Medicare. With most Medicare Advantage plans, you pay a portion of your plan cost out of pocket, but with a D-SNP, Medicare and Medicaid pay most or all of the costs. Medicare pays for a share of your medical costs first, then Medicaid pays any costs that may be left over. Medicaid is known as the second payer for costs that are not covered or only partially covered by Medicare.

The examples of the extra benefits D-SNPs may offer include:

  • Transportation assistance
  • Dental, hearing, and vision
  • Nutrition programs
  • Care coordination through a personal care coordinator
  • Fitness memberships

Enrolling in Dual-Eligible Special Needs Plans

You may, under certain circumstances, be automatically enrolled for Medicare parts A and B when you turn 65 years old. But you will not be automatically enrolled in a D-SNP because it is a type of Medicare Advantage plan.  To enroll in D-SNP, you must be eligible for or already enrolled in Medicare and Medicaid.

You can sign up for D-SNPs during the following Medicare enrollment periods:

  • Initial Enrollment Period (IEP)
  • Open Enrollment Period (OEP)
  • Annual Enrollment Period (AEP)
  • Special Enrollment Period (SEP) if there is a change in your circumstances

Need more information? Turning 65 Solutions can help.

We are very familiar with Dual-Eligible Special Needs Plans and can help you determine if it is right for you. Contact us today!

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