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What Is A Dual Special Needs Plan?



There are a lot of people that are eligible to have both Medicare and Medicaid. These individuals are referred to as “Dual Eligible” and they also qualify for a one of a kind Medicare Advantage Plan known as the Dual Special Needs Plan or DSNP.


Dual Special Needs Plans are rather complex with regards to coverage and requirements, but do provide the most comprehensive benefits to people that need them the most.


A dual special needs Medicare Advantage plan helps coordinate care by combining all of the benefits that are available for you in Medicare Part A, Medicare Part B and Medicare Part D Prescription Drug Plan with your benefits provided by Medicaid. Nearly all of the plans also provide additional benefits such as vision, dental, over the counter health products and fitness services.


Coverage of a Dual Special Needs Plan.


Like other Medicare Advantage Plans, the DSNP includes coverage for Medicare Part A and Part B. All DSNP plans also provide coverage for the Medicare Part D Prescription Drug Plan and may provide coverage for extra services that are not covered or provided by either Medicare or Medicaid.


Some of the extra benefits that are provided by a Dual Special Needs Plan are mentioned below:

  • Credits to buy health products

  • Transportation assistance

  • Care coordination via a personal care coordinator

  • Personal emergency response system (PERS)

  • Telehealth services

  • Virtual medical visits

  • Worldwide emergency coverage

Requirements for a Dual Special Needs Plan.


Unlike many other plans offered by Medicare or Medicaid, the Dual Special Needs Plan has a simple set of requirements.


In order to qualify for a DSNP you need to be eligible for both Medicare and Medicaid and have both of them.You must have Medicare Part A and Part B and must reside in the geographical area that is covered by a Dual Special Needs Plan.


Enrolling in a Dual Special Needs Plan.


Some individuals are automatically enrolled in Medicare Parts A and Parts B at the age of 65 or following 24 months of receiving social security disability benefits. You will not be automatically enrolled in a Dual Special Needs Plans. Contact your Medicare Insurance Specialist to find out what DSNP plans are available in your area and the specific benefits included in each plan. All DSNP plans are offered by private insurance companies.


Since the DNSP is a Medicare Advantage Plan, it can be purchased during the Medicare approved enrollment period. In most cases if you are “dual eligible” you qualify for a Special Enrollment Period (SEP) and can enroll at any time. You also qualify for a Special Enrollment Period to change plans once during each calendar quarter.


Confused by Medicare?


We are Independent Insurance Brokers, and have been appointed by many of the major insurance carriers. We can help you find the best policy for your individual situation. We work with clients in Winchester, VA, Martinsburg, WV, and Charles Town, WV.


Contact us today at (540) 662-4432 to schedule a FREE CONSULTATION with one of our Insurance agents or simply visit our website medicaretrustedagents.com to obtain more information.


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