Want to find out more about D-SNPs and how they work? We’re here to provide answers to some of the more commonly asked questions about these special needs plans.
What Is a Dual Eligible Special Needs Plan (D-SNP)?
A Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) is one type of Medicare Advantage plan designed for people who qualify for both Medicare and Medicaid.
Am I Eligible for a D-SNP?
If you qualify for both Medicare and Medicaid and you live in the plan’s service area, you may be eligible for a D-SNP.
How Can I Qualify for Both Medicare and Medicaid?
Medicare and Medicaid each have their own requirements for eligibility. Medicare is a federal health insurance program for people over 65, but some people with disabilities are also eligible. Find out more about Medicare eligibility here.
Medicaid is a joint federal and state health insurance program. Eligibility requirements vary by state. They can include things like income, financial assets, age, family size, disability and other factors. Find out more about Medicaid eligibility here.
When Can I Enroll in Medicare?
- Initial Enrollment Period (IEP): You can sign up for Original Medicare during the seven-month long IEP. It starts three months before your 65th birthday month and lasts until three months after.
- Annual Enrollment Period (AEP): AEP runs from October 15th to December 7th each year.
- Medicare Advantage Open Enrollment Period (MA OEP): MA OEP runs from January 1st to March 31st each year. If you're already enrolled in a Medicare Advantage plan, you can join, drop, or switch to another plan.
- Special Enrollment Periods (SEPs): These are available under certain circumstances, such as moving out of your plan's service area, losing access to existing health insurance coverage, or other unique circumstances.
How Do D-SNPs Differ From Other Medicare Advantage Plans?
A D-SNP combines the benefits of Medicare with the benefits of Medicaid for more comprehensive health insurance coverage at little to no cost to members. Coordination services can help integrate all the benefits included in the two programs and streamline care.
What Benefits Do D-SNPs Offer Beyond Original Medicare?
Because members often have greater needs, D-SNPs provide more in-depth support and enhanced benefits compared to what traditional Medicare and Medicaid offer. These benefits vary by plan and market, but may include:
- Dental care
- Vision care
- Hearing exams and hearing aids
- Prescription drug coverage
- Over-the-counter allowance
- Transportation assistance
- 24/7 Nurse line
- Telehealth options
To find out more about the benefits available with a Wellcare D-SNP, give us a call.
8 a.m.-8 p.m., 7 days a week.
How Does Enrolling in a Medicare Plan Affect my Medicaid Benefits?
Enrolling in Medicare or Medicare Advantage (including D-SNP) does not affect your Medicaid benefits. You won’t lose Medicaid eligibility if you enroll in a D-SNP.
Are Prescription Drugs Covered Under D-SNPs?
Yes, prescription drug coverage is typically included in a D-SNP. There is no need to choose a separate Part D plan. But it’s important to check your D-SNP plan for details on coverage of specific prescriptions. If you qualify for a D-SNP, you may also be eligible for the EXTRA HELP program which assists with the cost of prescription drugs.
Can I See Any Doctor With a D-SNP?
No, you’ll choose a primary care physician (PCP) that is within the plan network. Your PCP will get to know your health needs and coordinate your care with other providers. Wellcare D-SNP members have access to a large network of doctors, specialists, hospitals and pharmacies.
What Are the Costs Associated With Joining a D-SNP?
Exact costs will vary by plan and market, but D-SNP members often receive medical care at little to no cost. This is because both Medicare and Medicaid contribute to the overall cost of member care. Wellcare plans have limits on how much you’ll spend out-of-pocket, so you can stick to your budget. There are plans available with $0 or low premiums, deductibles and copays.
What Happens to my D-SNP if I Lose my Medicaid Eligibility?
It’s important to keep your Medicaid coverage current so that you can maintain your dual eligible status. If you lose your Medicaid eligibility while enrolled in a D-SNP, your benefits may be impacted. You might have to pay for services normally covered by Medicaid.
You may also be eligible to join another Medicare Advantage plan through a special enrollment period, since losing Medicaid coverage is typically considered a qualifying event. It’s best to contact your D-SNP provider to see how losing Medicaid will impact your coverage.
What Is the Difference Between D-SNP and C-SNP?
Both D-SNPs and C-SNPs are types of special needs plans. A D-SNP stands for Dual Eligible Special Needs Plan, and it’s designed for people who qualify for both Medicare and Medicaid. A C-SNP stands for Chronic Special Needs Plan, and it’s designed for people who have a chronic health condition like diabetes, cardiovascular disease, or congestive heart failure.
Call us today to learn more and enroll.
8 a.m.-8 p.m., 7 days a week.
More About Medicare Advantage
- What Is a Medicare Advantage Plan?
- What Is a D-SNP? Understanding Dual Special Needs Plans
- What Is a PPO?
- What Is an HMO?
- Medicare HMO vs. PPO Plans: What’s the Difference?
- Medicare Advantage vs. Original Medicare
- What Is the Medicare Advantage Open Enrollment Period (MA OEP)?
Sources
CMS.gov - Dual Eligible Special Needs Plans
U.S. Department of Health and Human Services – Who’s eligible for Medicare?
Medicaid.gov – Medicaid Eligibility
