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Dual Eligible Special Needs Plans, also known as D-SNPSs, are special Medicare Advantage plans for those who are receiving both Medicare AND Medicaid assistance. These plans extend their Medicare coverage and help coordinate care and benefits between Medicare and Medicaid. They can ultimately provide the most comprehensive, affordable coverage for these individuals.
These plans cover the same health care services that traditional Medicare Advantage plans cover, including Medicare Parts A and B and they also include prescription drug coverage. Many D-SNPs also offer Dental, Vision and Hearing coverage, Personal Emergency Response Systems (PERS), tele-health options, fitness and gym memberships, OTC (Over the Counter) cards (with prepaid credit to buy health products and groceries) and even transportation assistance. Many of these plans offer $0 premiums making them highly attractive to those with limited incomes.
Individuals who are eligible for D-SNPs are a diverse group of people that can include those with multiple chronic conditions, physical disabilities, mental illnesses, cognitive impairments and developmental disabilities. It can also include individuals who are relatively healthy. These individuals typically require assistance managing their care, which is where the care coordination of these plans is hugely beneficial for them.
Who pays for what and how does it all work? With most Medicare Advantage plans, your client pays a portion of the plan cost out of pocket. With a D-SNP, Medicare and Medicaid pay most or all of the costs. Medicare is the primary payer for care services. State-run Medicaid then steps in by providing assistance with Medicare premiums and cost sharing and also covers some services that Medicare does not cover, such as Long-term care services.
In 2020 there were 12.3 million people enrolled in both Medicare and Medicaid.
This is a very under-served market and there is no shortage of potential clients who could benefit from a Dual Special Needs Plan.
If you have clients that are currently enrolled in both Medicare and Medicaid programs, discuss the benefits of enrolling them in a D-SNP. There are a variety of D-SNPs available. Some are Health Maintenance Organizations programs and some are Preferred Provider Organizations programs. These plans vary by state and by insurance carrier, so it's important to research plans in your client's area thoroughly before enrolling them. Premiums, copayments, coinsurances, and deductibles also vary depending on the plan.
You can enroll clients during their Initial Enrollment Period, during the Medicare Annual Enrollment Period (October 15th - December 7th), during the Medicare Advantage Enrollment Period (January 1 - March 31) or during a Special Enrollment period: January–March, April - June or July - September, if they have a qualifying event which allows them to do so. To learn more about the different enrollment periods, visit CMS.gov or Medicare.gov.
If you're looking to find potential D-SNP prospects, you're likely to find them in low income housing communities, senior centers, churches, and certain retirement communities. Volunteering at food banks, charity events and community centers is a good way to reach out and help those who may be eligible.
If you have questions about Dual Special Needs Plans or need help offering them, please reach out to us.
Carolyn Portanova is the Director of Marketing at The Brokerage Resource and has been with the firm since 2012.
1480 Chapel Ridge Road
Apex, NC 27502