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Plans For Dual Eligible Medicare Beneficiaries

Medicare Advantage for people with both Skeptical Senior WomanMedicare 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.

This type of Medicare Advantage plan will include Medicare Part D as well as extra benefits that are not normally part of Medicare. Benefits often include, dental, vision, hearing and transportation to and from medical appointments.

Special Needs Plans for people who are dual eligible normally do not require a premium. Traditional Medicare Advantage Plans may or may not require monthly premiums but typically require cost sharing through deductibles, co-payments and co-insurance.

For this reason, you should enroll in a Special Needs Plan if one is available in your area.

Dual eligible special needs 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 traditional 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 are enrolled in  the right plan.


2 comments

  1. How do I get enrolled in the duel medicare plan. Please advise me.
    Thank you

    margie ludvik

  2. Margaret, You should first make sure that a plan or plans are available. Visit medicare.gov and search for plans in your area. As long as you qualify you can enroll at anytime. You could enroll through the Medicare website but I would recommend that you speak with a licensed agent in your area. Once you locate a plan you could go online and search for a local agency that represents that plan.

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