You may qualify for a Dual-Eligible Special Needs Plan (DSNP) if you get healthcare benefits from both Medicare and Medicaid. A DSNP is a type of Medicare Advantage plan that provides healthcare coverage for people who are eligible for both programs.
Private insurance companies in many states offer DSNPs. These insurance companies are required by United States federal law to offer plans that have, at least, the same coverage as Original Medicare Part A (hospital insurance) and Part B (medical insurance), as well as Part D prescription drug coverage. Many DSNPs also provide extra benefits such as preventive care services, wellness management programs, and fitness club memberships, for example.
If you are interested in enrolling in a DSNP, there are three different enrollment periods when you can do so: the Initial Enrollment Period, Annual Election Period, and a Special Enrollment Period.
When can you enroll in a DSNP?
As soon as you become eligible for Original Medicare you can enroll in a DSNP or other type of Special Needs Plan if one is available in your local service area. Most people become eligible for Medicare on their 65th birthday and use their Initial Enrollment Period to sign up for healthcare coverage then. People under the age of 65 who qualify for Medicare based on a disability may be eligible for Medicaid at the same time, and may be able to enroll in a DSNP when they first enroll, as well.
The Initial Enrollment Period (IEP)is a seven month period which begins three months prior to the month containing your 65th birthday. It includes the entire month of your birthday and continues for three months after that month.
If you have been receiving Social Security or Railroad Retirement Board disability benefits for 24 months, you become eligible for Medicare even if you are not 65. Your initial enrollment period begins three months before your 25th month of receiving SS or RRB benefits, includes the entire 25th month, and continues for three months beyond.
The Annual Election Period (AEP) runs from October 15th to December 7th every year. During the Annual Election Period you can enroll in a Special Needs Plan like a DSNP. You have the choice during AEP to change from one Medicare Advantage plan to another, drop your MA plan and revert to Original Medicare, or change your prescription drug coverage.
You may also use a Special Enrollment Period (SEP), also known as a Special Election Period, to sign up for a DSNP or other Special Needs Plan. This is a period of time that may occur due to a qualifying life event at any time of the year. You may qualify for a Special Enrollment Period for a number of reasons, including moving out of your current plan’s service area, losing creditable group health insurance due to employment ending, or being released from jail. Some of the qualifying events that can qualify you to enroll in a DSNP during this period include:
- Nursing home residency. Whether you are moving in, moving out, or are currently living in a nursing home, you can enroll in a Special Needs Plan for the first time, you can switch plans, or opt out of one you are currently enrolled in.
- Medicaid qualification. If you already have Medicaid benefits, or become eligible, you can enroll in a Special Needs Plan at any time.
- If you move outside the service area covered by your current Special Needs Plan and you want to switch to another plan, you can do it during the SEP. If you do not enroll in a different DSNP, you are automatically returned to coverage through Original Medicare.
- Your DSNP leaves Medicare. At this time you can sign up for a different DSNP.
If your situation changes at any time during your enrollment in a DSNP and you are no longer eligible for this type of plan, you will have a Special Election Period to dis-enroll in your Special Needs Plan and sign up for either a Medicare Advantage policy or re-enroll in Original Medicare.
The availability of DSNPs depends on where you live. If you are a dual-eligible beneficiary and would like more information on plans available in your area, you can compare the plans available in your area and find the one that’s right for you.