Dual Eligible Special Needs Plans

Dual Eligible Special Needs plans (DSNP) are available to serve the individuals who are eligible to receive both Medicare and Medicaid benefits.

You must also be enrolled in Medicare Parts A and B first before you add your DSNP.

How do Dual Eligible Special Needs Plans work?

A DSNP is a type of Medicare Advantage plan that provides health benefits for those who qualify for both Medicare and Medicaid. 

States will determine benefits but, in general, cover: 

  • Vision and hearing
  • Over-the-counter drugs
  • Transportation to and from healthcare visits
  • Gym memberships and classes
  • Prescription drug benefits

They also typically come with no additional monthly premium than anything you already pay.

Of course, all Medicare Part A and Part B benefits are also included.

How do I know if I’m eligible for a DSNP?

To receive a Dual Eligible Special Needs Plan, you need to be qualified for Medicare and Medicaid. 

You can sign up for Medicare three months before the month you turn 65 to three months after. Or you need to have a qualifying disability. 

To be eligible for Medicaid, your income and asset level has to be below a certain amount determined by the state you live in.

How to enroll

If you’re eligible for Original Medicare, you’re eligible for an Advantage plan. 

You can enroll during your initial enrollment period (when you can initially enroll in Medicare). This is a seven-month period that starts three months before the month you turn 65 and ends three months after the month you turn 65.

There is also the annual election period that spans from October 15 through December 7 every year. 

Finally, you may be eligible for a special election period if there have been significant changes in your coverage or income. 

You can find out if you are eligible by speaking with a licensed Medicare agent, but here are some instances where you would be eligible: 

  • You move outside your current plan’s area
  • Suffered unintentional loss of coverage
  • Got married
  • Had a baby

There are many more ways you can become eligible for a special election period. So, again, be sure to ask an insurance agent.

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