Dual-Enrollment Special Needs Plans (D-SNPs) provide healthcare coverage to those in financial need. People who qualify for both Medicare and Medicaid are eligible for a plan.
D-SNPs are inexpensive with a wide range of cost coverage and benefits. They only work, however, if you are eligible.
You must have both Medicare and Medicaid to have the opportunity to enroll in a D-SNP. Medicare eligibility is easy—you qualify if you meet at least one of these requirements:
- You Are 65 Years Old or Older
- Have End-Stage Renal Disease (ESRD) or ALS
- Have Received Social Security Disability Benefits for at Least 24 Months
While Medicare is based on these factors, Medicaid eligibility is based on your financial status. The only qualification is based on your Modified Adjusted Gross Income (MAGI). You are, however, exempt from most major monetary considerations if you qualify for Medicare, which, in this case, you likely do. If you are enrolled in Medicare, your Medicaid eligibility is instead based on your Supplemental Security Income (SSI) rather than MAGI.
Once you know if you qualify for a D-SNP, you will need to officially enroll to receive coverage. The first step in this process is to enroll in Original Medicare (Parts A and B) if you have not yet already. You will more than likely be automatically enrolled—but, if not, you can easily do so by following the instructions on the official Medicare packet when it arrives in the mail.
Next, you must make sure you are currently receiving Medicaid. This coverage should begin as soon as you meet the requirements for automatic enrollment.
If you have ESRD, a disability, or have become eligible for a D-SNP within the past month, you will be able to enroll using a Special Enrollment Period (SEP). This means that you will not have to wait for a certain time in the year to apply.
If, however, you cannot use a SEP, you will have to enroll during the Annual Enrollment Period (AEP) that takes place from October 15th through December 7th.
There are many health and financial benefits to D-SNPs. Specific benefits include:
- $0 monthly premiums
- Care coordination
- Vision and hearing benefits
- Transportation benefits
- Telehealth services
- Gym memberships
- Part D coverage
On top of this, you will have little-to-no out-of-pocket costs for the healthcare you receive. You may have to pay for some of your prescriptions, but it will be at a significantly reduced rate compared to your average Part D plan.
Fully covered healthcare services include (but are not limited to):
- Inpatient Copayments
- SNF Copayments
- PCP Copayments
- Specialist Copayments
- Ambulatory Surgery
- Outpatient Hospital
- Emergency Room Visits
- Diagnostic Imaging
If you are eligible for Medicare benefits, you can enroll in your preferred plan during the following standard periods:
- Initial Medicare Enrollment Period: This period begins three months before you turn 65 and ends three months after you turn 65. The Initial Enrollment Period also includes your birth month, adding up to a total of 7 months where you are eligible for enrollment
- General Medicare Enrollment Period: The General Medicare Enrollment period is for people who do not enroll during their Initial Enrollment Period. It spans January 1 to March 31. People who enroll during this period will receive coverage on July 1.
- Special Enrollment Period: Under certain conditions, you may be eligible for a Special Enrollment Period that falls outside of the standard periods listed above. Consult with an expert to learn if your situation qualifies you for a Special Enrollment Period.
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