Dual Eligible Medicare Beneficiaries
Medicare Advantage for those with both 
Medicare and Medicaid
Many Medicare beneficiaries are also enrolled in their State’s Medicaid program due to having a lower income. Dual eligible Medicare beneficiaries may have access to Special Needs Plans designed especially for them.
If you qualify for a Special Needs Plan (SNP), as a dual eligible Medicare beneficiary, you should enroll in this type of Medicare Advantage plan over any other. Medicare Advantage Plans typically require cost sharing for the member through deductibles, co-payments and co-insurance. These fees may be more than what would be required if you had only Medicare and Medicaid.
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Dual eligible SNP benefits
Benefits of enrolling in a Dual Eligible SNP are typically much richer than other types of Advantage Plans. This type of plan is generally a network based plan and not a private fee-for-service plan. Most often there are no deductibles, co-pays or co-insurance as long as the member remains in network.
These plans often include additional benefits, such as transportation to and from doctor visits and the pharmacy. Transportation will generally be limited to a certain number of one way trips. Many plans also include a catalog of health related items as well as vitamins and supplements, that the member may order from and receive either a substantial discount, or in some cases, a quarterly allowed amount to use toward purchases.
Enrolling in a Dual Eligible SNP
Medicare beneficiaries who are dual eligible are not subject to the restrictions of the Annual and Open Enrollment Periods. Dual eligible members can enroll in a SNP at any time during the year. They are also able to change plans at anytime.
If a Medicare plan member qualifies for their State’s Medicaid benefit and they are in a traditional Advantage Plan, they should not wait for the annual enrollment period, as their becoming Medicaid eligible affords them a special enrollment period.
If you are a dual eligible medicare beneficiary and do not have a SNP, you should contact your Advantage Plan’s customer service and ask if they offer a dual eligible plan. If they do not offer a dual eligible plan, you should contact your State’s Medicaid office and ask them for a referral. It’s important that if you are a dual eligible Medicare beneficiary, you have the right plan.
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