For millions of Americans who qualify as dual-eligible healthcare beneficiaries, trying to coordinate their health care with both Medicare and Medicaid services can be confusing. For this reason, there are Special Needs Plans from Medicare Advantage that provide you with a convenient way to manage your healthcare services under one policy. People who have dual eligibility status can sign up for a type of Special Needs Plans known as a Dual-eligible Special Needs Plan, or DSNP.
DSNPs are specialized Medicare Advantage plans that provide healthcare benefits for beneficiaries that have both Medicare and Medicaid coverage. Most DSNPs are categorized as either HMOs (Health Maintenance Organization plans) or PPOs (Preferred Provider Organization plans).
DSNPs are available through certain private insurance companies in some states, but not all. These plans are required by federal law to provide all benefits covered by Original Medicare Part A (hospital insurance) and Part B (medical insurance) and individual states control the additional benefits that providers can include in the DSNP.
Based on your degree of eligibility for Medicaid, you can enroll in one of the five different types of DSNP:
• Medicare Zero Cost Sharing
• Dual Eligible Subset
• Dual Eligible Subset Medicare Zero Cost Sharing
Who is eligible for a DSNP?
You may be eligible to sign up for a DSNP if you have dual coverage from Medicare and Medicaid. To qualify for Medicare benefits you must meet the following requirements:
• You must be a United States citizen or have been a legal resident for at least five years.
• You must be 65 years old or have a qualifying disability if younger than 65.
• You must have worked and paid Social Security taxes for 40 quarters (10 years), at least.
To qualify for Medicaid services you must meet the following requirements:
• You must have an income level that does not exceed your state’s income threshold. According to the national average in 2020, the qualifying income level for a 65 year old individual cannot be more than $2,349.00 per month.
• You must be a United States citizen or meet other immigration requirements and live within the state where you apply.
• You must have a Social Security number.
Also, to qualify for Medicaid, you must meet at least one of the following requirements:
• Age of at least 65 years old
• A permanent disability (according to the Social Security Administration)
• A child, parent, or caretaker of a child
What do DSNPs cover?
While DSNPs are like Medicare Advantage plans in the coverage they offer, they are adapted for people who meet income and special needs qualifications and are only available for dual-eligible beneficiaries.
On a federal level, DSNPs provide the same standard benefits included in Original Medicare and Medicaid services. Individual states determine what additional benefits can be included. All DSNPs include prescription drug (Part D) coverage. Some of the extra benefits that can be found in DSNPs include:
• No charge for monthly premiums
• Healthcare coordination and management assistance
• Vision care
• Hearing care
• Dental care
• Over-the-counter benefits every three months
• Transportation to and from medical appointments
• Telehealth services
• Fitness program memberships
• Routine foot care for diabetics
• Chiropractic care
These extra benefits vary between plans and states. When you enroll in a DSNP you should discuss all the additional benefit allowances with a representative of the insurance provider.