DSNPs or Dual Eligible Special Needs Plans are Medicare Advantage plans specifically for individuals who qualify for both Medicare and Medicaid. If you are a Medicare agent, you may know about recent changes in enrollment periods for DSNP members. Some agents are wondering, what are fully integrated DSNPs.
Fully integrated DSNPs are a unique type of plan that provides comprehensive coordination between Medicare and Medicaid benefits. If you’re assisting clients with dual eligibility, understanding fully integrated DSNPs is essential.
What Does “Fully Integrated” Mean
A fully integrated DSNP plan goes beyond the standard DSNP by seamlessly coordinating all Medicare and Medicaid benefits under one umbrella. This integration ensures that members receive comprehensive, streamlined care without the confusion of navigating 2 separate programs.
Key features of fully integrated DSNPs:
Single plan design – Plan members have one plan that administers both Medicare and Medicaid benefits. This simplifies coverage and reduces administrative headaches.
Care coordination – These plans include a dedicated care team that provides the member with holistic support to manage medical, behavioral, and social service needs.
Combined benefits: Fully integrated DSNPs combine Medicare and Medicaid services, including medical, prescription drug, and long-term care benefits.
HIDE and FIDE: Understanding the Integration Levels
Fully integrated DSNPs can vary in how they coordinate benefits. Two common models are Highly Integrated Dual Eligible (HIDE) and Fully Integrated Dual Eligible (FIDE) plans. The main difference between the two plans is the level of integration.
Highly Integrated Dual Eligible (HIDE) Plans
HIDE plans provide a significant amount of benefit coordination between Medicaid and Medicare. This plan option may not fully integrate all services. In general, these plans focus on aligning medical and behavioral benefits. Although, in some cases, Medicaid benefits such as; LTSS, some skilled nursing facility care or behavioral health may be managed through the DSNP or an affiliated Medicaid managed care plan.
The HIDE plans are a good option for those who prioritize coordinated medical and behavioral health but may not require extensive long-term care services.
Watch a quick YouTube video on 2025 DSNP SEP changes
Fully Integrated Dual Eligible (FIDE) Plans
FIDE plans represent the highest level of integration, combining Medicaid and Medicare benefits, including long-term care, under one plan. This ensures a single point of contact for all healthcare needs. The plans provide comprehensive coverage and total coordination of care. This includes LTSS, nursing facility care for a period of at least 180 days per year and behavioral health services. It also includes medical supplies, equipment and appliances.
Plans are best for those with complex health needs requiring seamless access to long-term care, medical, and behavioral health services.
For a more detailed definition DSNP plan types, click here
Benefits of Fully Integrated DSNP Plans
Fully integrated DSNPs offer several advantages for eligible individuals:
Simplified coverage
Members no longer need to juggle multiple insurance cards or deal with separate billing for Medicare and Medicaid. One plan manages all medical services.
Enhanced care coordination
These plans emphasize comprehensive care management, with dedicated care coordinators ensuring members receive the right care at the right time.
Additional benefits
Many fully integrated DSNPs offer extra perks such as dental, vision, hearing, transportation, and OTC allowances that are not always available with standard Medicare or Medicaid coverage.
Cost savings
In most cases, fully integrated plans have little to no out-of-pocket costs for covered services, as Medicaid typically covers premiums, copays, and other costs.
Who Is Eligible for Fully Integrated DSNPs
Eligibility for a fully integrated DSNP plans require dual eligibility for both Medicare and Medicaid. Specific criteria vary by state but generally require eligibility for Part A and enrollment in Part B as well as qualification for enrollment in the state’s Medicaid program.
Important: fully integrated DSNPs are not available in all states. Availability depends on state-specific Medicaid programs and participating insurance carriers.
Examples of Fully Integrated DSNPs
Medicare-Medicaid Plans (MMPs) – These are a type of fully integrated DSNP operating under state-specific agreements with the federal government.
Programs of All-Inclusive Care for the Elderly (PACE) – While not technically a DSNP, PACE programs also provide fully integrated care for dual-eligible individuals.
Considerations When Choosing a Fully Integrated DSNP
If your client is considering enrolling in a fully integrated DSNP, it is still important to check the provider network and prescription coverage. Once you establish the client’s providers are in network and medications are on formulary, consider the desired additional benefits.
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Fully integrated DSNP plans provide a powerful solution for individuals eligible for both Medicare and Medicaid, offering simplified coverage, enhanced care coordination, and valuable additional benefits. Understanding the differences between HIDE and FIDE plans can help you choose the right level of integration based on your or your client’s needs.
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