Dual Eligible Special Needs Plans – DSNP – Medicare, and Medicaid

by Fitzgibbons | April 14, 2021 9:49 am

There are special types of Medicare Advantage Plans that are designed for those with specific needs or if they meet certain criteria. These plans are called Special Needs Plans or SNP’s. One of those kinds of SNP’s is called a Dual-Eligible Special Needs Plan or a D-SNP. This plan is designed for people who have both Medicare and Medicaid benefits, also known as “dual eligibles.” SNPs cover all of the same core Medicare benefits that other Medicare Advantage plans must cover and have additional benefits tailored to the special groups they serve; in this case, those that are dual-eligible. Each plan offered by different insurance companies can have different benefits, so to see exactly what additional benefits are provided, you will need to review the specific D-SNP plans sold by each insurance company in your area.

States cover some Medicare costs, depending on the state and the individual’s eligibility. There are several different categories of Medicaid eligibility, and not all D-SNP’s accept enrollment from all categories. The Medicaid eligibility categories are listed below:

• Full Medicaid (only)
• Qualified Medicare Beneficiary without other Medicaid (QMB Only)
• QMB Plus
• Specified Low-Income Medicare Beneficiary without other Medicaid (SLMB Only)
• SLMB Plus
• Qualifying Individual (QI)
• Qualified Disabled and Working Individual (QDWI)

Different states determine eligibility categories differently, so there may be state-specific differences in the eligibility levels compared to those listed here.  For specific information regarding Medicaid eligibility categories, refer to the Medicaid website[1] or work with an experienced Medicare agent, like Maura O’Toole, who can help you determine if you are eligible for a D-SNP.

There are many benefits of enrolling in a D-SNP plan, including prescription drug coverage, expanded access to hospitals and physicians, and other benefits that may include things like:

• Allowance for OTC products
• Medical transportation benefits
• Dental services
• Vision services including contacts & eyeglasses coverage
• Hearing aids
• Fitness memberships
• Meals delivered after you are released from the hospital
• And more

As stated previously, the exact benefits, you will receive depend on the D-SNP you enroll in.

One of the other benefits many D-SNP plans offer is connecting members with other community resources they may need. They provide this service because, many times, accessing these available services can be complicated and overwhelming. Some D-SNP plans have social workers who are experts in the local area at connecting D-SNP members with community resources. Community resources can include many different things, from food banks to programs to ensure your electricity or gas isn’t shut off.

Just as the medical benefits provided by different D-SNP plans can be different, the drug formulary (the list of covered drugs), out-of-pocket costs (although D-SNPS often have low or no out-of-pocket costs or premiums), and provider and hospital networks can be different for an insurance companies D-SNP than their other Medicare Advantage plans. If you are considering enrolling in a D-SNP plan, consider working with an experienced independent agent like Maura O’Toole at the FitzGibbons Agency, who can be reached directly at 315-312-0803.

Have further Questions? Just Ask Fitz!

Maura O’Toole

FitzGibbons Agency
44 E Bridge St, Suite 1
Oswego, NY 13126
(315) 312-0803

www.askfitz.com[2]

 

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