Medicare Dual Plans

Medicare Dual Plans

Medicare dual plans are also called dual eligible special needs plans.  A Dual Eligible Special Needs Plan are know as a D-SNP. Plans are Medicare insurance plans that enrolls beneficiaries who are entitled to both original Medicare on a federal level and their state’s Medicaid plan. Depending on the state, many individuals on these plans will receive assistance with out-of-pocket costs, among other things. D-SNP plans are Medicare Advantage plans.

There are limited eligibility categories for this plan. To be eligible for dual enrollment, individuals must meet at least two categories simultaneously, one from Medicare eligibility and one from Medicaid eligibility.

To be qualified for original Medicare, an individual must be 65 years or older, a citizen of the United States of America, and live here the majority of the year. For some people who have chronic conditions such as end-stage renal failure, some cancers, or ALS, Medicare eligibility can come earlier because of their condition.

Medicaid requirements for enrollment are more complex, however, because they are state-dependent and can differ greatly by where an individual lives in the country. Generally speaking, those who are eligible for Medicaid must fall under a certain income threshold to be eligible for these benefits. There are some exceptions in Connecticut. For example, there are some disabilities that automatically qualify people for Medicaid benefits, known as Husky in Connecticut. The majority of the time, people who are 65 years or older and make under a certain percentage of their state’s income thresholds are considered dual eligible, or qualified to enroll for a D-SNP.

How Do You Know If You Qualify for One of the Medicare Dual Plans?

Despite the differences in state qualifiers, individuals who answer yes to the following questions are typically qualified for a D-SNP.

• Do you qualify for Medicaid or get financial assistance from your state?

• Enrolled in Medicare parts A and B?

• Do you live in the coverage area of the dual enrollment plan’s insurance carrier?

Potential beneficiaries able to answer yes to these three questions are likely eligible for a Dual Enrollment Special Needs Plan.

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