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For people balancing several health needs, seeing multiple specialists, or managing both Medicare and Medicaid, figuring out how coverage works together can be confusing — whether you are handling your own care or helping someone else.
Dr. Edith Allen, a medical director at UnitedHealthcare, has spent her career helping patients navigate and manage their healthcare.
She answers common questions about Dual Special Needs Plans, also known as D-SNPs, and explains how they may help connect coverage and care in support of better health.
1. What is a Dual Special Needs Plan, or D-SNP?
Dr. Allen: A Dual Special Needs Plan, commonly called a D-SNP, is a type of Medicare Advantage plan for people who have both Medicare and Medicaid.
D-SNPs coordinate Medicare coverage with Medicaid benefits, which people continue to receive as long as they remain eligible. Depending on the plan and eligibility, a D-SNP may have a $0 monthly premium.
2. Why can care coordination be helpful for people managing multiple health needs?
Dr. Allen: When you are dealing with multiple health needs, disabilities or chronic conditions such as diabetes or high blood pressure, you may be seeing several doctors and keeping track of appointments and follow-up care.
D-SNPs may provide care coordination to help you understand your coverage, find in-network doctors and hospitals, keep track of appointments, and manage follow-up care across multiple providers and services.
3. What might that support look like for an individual patient?
Dr. Allen: Healthcare is personal. Everyone’s health needs and treatment goals are different. A D-SNP may help create an individual care plan with you and your care team based on your medical, emotional and social needs and treatment goals.
This care plan may include help staying current with preventive care. Annual wellness visits and recommended screenings may help identify health concerns earlier.
A D-SNP may also help connect you with community resources and services that support your needs beyond physical health.
4. Can D-SNPs help with needs outside the doctor’s office?
Dr. Allen: Many things can affect your overall health, including diet and nutrition, keeping up with dental, vision and hearing care, and even getting to doctor’s appointments.
Depending on the plan and your eligibility, some D-SNPs may offer extra benefits that can help with certain everyday needs and expenses, including healthy food and certain over-the-counter products; dental, vision and hearing care; and rides to medical appointments and the pharmacy. Some benefits, including help with healthy food or utilities, have additional eligibility requirements, so compare plan options and benefits carefully.
5. What should people with Medicare and Medicaid and their families know during Medicare’s Annual Enrollment Period?
Dr. Allen: Medicare’s Annual Enrollment Period runs from Oct. 15 through Dec. 7. If you or a loved one has Medicare and Medicaid, you may qualify for a D-SNP.
Take time to understand your or your loved one’s eligibility and health needs, and how a plan may support that care. Different companies offer D-SNPs, and benefits, eligibility and plan availability vary.
To learn more about D-SNPs, visit GetDual.com.
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan's contract renewal with Medicare.
Benefits, features and/or devices may vary by plan/area. Limitations, exclusions and/or network restrictions may apply.
Dual Special Needs plans have a $0 premium for members with Extra Help from Medicare (Low Income Subsidy). Some of the benefits on a Dual Special Needs plan may also be available from the state Medicaid program or a managed Medicaid plan.
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