A physician shares 5 key facts about Dual Special Needs plans for people with Medicare and Medicaid

Sponsored by UnitedHealthcare

For people balancing several health conditions, seeing multiple doctors, or dealing with both Medicare and Medicaid, it can be difficult to understand how the healthcare system fits together, whether for yourself or for a loved one.

Dr. Edith Allen, a medical director at UnitedHealthcare, has spent her career helping patients navigate and manage their care.

Below, she answers common questions about Dual Special Needs Plans and how they may help unify coverage and care to support better health.

1. What is a Dual Special Needs Plan, or D-SNP?

Dr. Allen: A Dual Special Needs Plan, often called a D-SNP, is a type of Medicare Advantage plan designed for people who have both Medicare and Medicaid.

D-SNPs coordinate Medicare coverage with Medicaid benefits, which people can 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're managing several health needs, disabilities, or chronic conditions such as diabetes or high blood pressure, you may be seeing different doctors and keeping track of appointments and follow-up care.

D-SNPs may include 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 doctors and services.

3. What might that support look like for an individual patient?

Dr. Allen: Healthcare is personal. Everyone has different health needs and treatment goals. A D-SNP may help create an individual care plan with you and your care team based on your medical, emotional, and social needs, as well as your treatment goals.

This care plan may include support for preventive care. Annual wellness visits and recommended screenings may help identify health concerns earlier.

A D-SNP may also 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 factors can affect overall health, including diet and nutrition, staying up to date with dental, vision, and hearing care, and even getting to doctor's appointments.

Depending on the plan and your eligibility, some D-SNPs may provide extra benefits that can help with certain everyday needs and expenses, including healthy food and some 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 extra eligibility requirements, so it's important to 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 the eligibility requirements and health needs involved, 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.

The healthy food and utilities benefit is a special supplemental benefit available only to chronically ill enrollees with a qualifying condition, such as diabetes, cardiovascular disorders, chronic heart failure, chronic high blood pressure and/or chronic high cholesterol, who also meet plan criteria indicating they are at high risk for hospitalization and eligible for intensive care coordination. There may be other qualifying chronic conditions not listed. If you use this benefit for certain utilities, it may be considered income for housing assistance. Check with your housing authority for details.