What is a DSNP
If you are an insurance agent or you have seen some of the Medicare commercials on tv, you have probably heard about dual eligible special needs plans or DSNPs. This might make you wonder, what is a DSNP.
DSNPs are Medicare Advantage plans that provide specialized healthcare benefits to qualified individuals who have both Medicare and Medicaid benefits.
Why are DSNP plans a good choice
For many beneficiaries who qualify for dual-eligible healthcare benefits, it may be difficult to coordinate their health care benefits between Medicare and Medicaid. That is why the DSNP (special needs plans) area a good choice. These plans provide members with an easy way to manage their healthcare coverage with the use of 1 plan as opposed to multiple plans and ID cards.
DSNP plans all include prescription drug coverage as well as some of the benefits in listed below.
Please note: each plan provides its own list of benefits. To view a full list of benefits for a particular plan, check the Summary of benefits or evidence of coverage.
- $0 plan premiums
- Coordination of healthcare services
- Dental benefits
- Hearing benefits
- Hearing benefits
- An allowance for OTC items
- Free transportation to and from doctor’s visits
- Fitness programs
- Telehealth services
- An allowance for healthy foods or other items
Who offers DSNP plans
DSNPs are offered to qualified beneficiaries through private insurance companies. The insurance companies that offer the plans are required to include all benefits that Original Medicare covers (Part A & Part B). Each individual state controls the extra benefits that providers can offer. These plans are not available in all states.
You can quickly find out which plans are available in each state by running a quote on Connecture or Sunfire.
Click here to watch a quick YouTube video on using Connecture and Sunfire
There are different types of DSNP plans
Each type of DSNP is based on your level of eligibility for Medicaid. Insurnace carriers offer a limited choice of DSNP plans based on the service area. The level are as follows:
- All-Dual
- Full-Benefit
- Medicare Zero Cost Sharing
- Dula Eligible Subset
- Dual Eligible Subset Medicare Zero Cost Sharing
Who is eligible for a DSNP plan
Beneficiaries may be eligible for a DSNP plan if they have dual coverage from both Medicare and Medicaid. In order to qualify for Medicare benefits you must:
- Either be a US citizen or a legal resident for a minimum of 5 years.
- Be 65 years old or have a qualifying disability if you are under 65 years old.
- To qualify for free Medicare Part A, you need to have worked at a Social Security qualified job for at least 40 quarters (10 years).
In order to receive Medicaid benefits, you must:
- Be a US citizen or meet other immigration requirements and reside in the state in which you qualify.
- Have a valid Social Security number.
- You must either be 65 or older or have a permanent disability as defined by the Social Security administration.
- Have an income level that does not exceed your state’s income threshold.
Find out if you qualify for state Medicaid benefits
As a licensed insurance agent, you can help sort out all the plan choices as well as the additional benefits each plan offers so your clients feel confident in their plan choice.
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