What You Need to Know to Assist Seniors with Dual Special Needs Plans (D-SNPs)

Most seniors are on a fixed income and now more than ever, they are facing budgetary constraints due to increases in the cost of living. Many find that as their healthcare and health insurance costs increase, their retirement funds are not keeping pace with inflation.

You play an important role in advising seniors who might be eligible for these Special Needs Plans. SNPs are on the rise and D-SNPs in particular are becoming more common as an affordable option. Not only will your clients benefit financially, but you may also help improve their overall healthcare experience by making the healthcare system easier for them to navigate.

Adding SNPs as a service you provide is a great option for your bottom line too. Because you do not have to wait for Annual Open Enrollment, this is also an opportunity for you to generate business year-round.

What is a D-SNP?

D-SNPs are unique Medicare Advantage plans that serve Medicare enrollees who are also eligible for Medicaid (dual eligibility). Seniors who have dual coverage can find it very difficult to navigate both. This audience often has the highest need, and the fragmentation of care can lead to gaps in healthcare. D-SNPs help by coordinating coverage under a single plan. They can be a great option for those who qualify.

Special Needs Plans cover the same health care services as all Medicare Advantage plans, including Medicare Part A and Part B. All Special Needs Plans are required to provide prescription drug coverage. Additional coverage may include dental, vision and hearing coverage, care coordination via a personal care coordinator, personal emergency response system, tele-health options such as virtual medical visits with a doctor, credits to buy health products, plus transportation assistance and more. These are just a handful of examples of the extra benefits D-SNPs typically include. But each plan is different, and can vary by state and county, so be sure to look at what's available where your client lives.

Who Qualifies for a Dual Special Needs Plan?

D-SNPs are available to those who meet the following criteria:

• They have original Medicare (Parts A and B)
• They have, or quality for, full Medicaid benefits - Each state, like Arizona, has online resources to help your clients determine if they are eligible for Medicaid
• They live in the dual-eligible plan’s coverage area based on their home address.

What Happens to Medicaid Benefits after Enrolling in a D-SNP?

A Dual Special Needs Plan doesn't replace your client’s Medicaid plan or change their Medicaid eligibility. They will keep the same Medicaid plan they have today, with the same Medicaid benefits.

When to Enroll In A D-SNP

Your client may not have to wait. The Medicare Annual Enrollment Period (AEP) happens once a year in the fall and anyone who is eligible can change their health plan at that time. But if your client qualifies for a Dual Special Needs Plan, they may be able to enroll right away.

People who are eligible for both Medicare and Medicaid can switch plans four times a year: once between January and March, once between April and June, once between July and September and once during AEP.

After they are enrolled in a dual health plan they don’t have to renew. As long as they stay eligible, their dual health plan will renew automatically each year. But they do need to recertify for Medicaid every year to stay qualified for a dual health plan.

Check in with Your Clients on a Regular Basis

A lot can change in a year for your clients, from their finances to their health. If they have experienced a change in their situation, their current Medicare plan may not be fulfilling their needs. You don’t need to wait until the next AEP. If they potentially need a new plan, see if they qualify for a Special Enrollment Period to join a Special Needs Plan.

We encourage you to get familiar with your local D-SNP carriers and to know which states and counties have these plans available. Most states that offer these plans, like Arizona, have online resources available to guide you.

We are here to support your Medicare sales success. Contact us today with any questions.