If you are enrolled in Medicare and qualify for your State’s Medicaid program you may have some additional choices when it comes to a Medicare Plan.Individuals with both Medicaid and Medicare are considered to be dual eligible.
There are Special Needs Medicare Plans available for certain categories of individuals, including those that have both Medicaid and Medicare.
There are three types of Special Needs Plans (SNP’s)
- Dual eligible SNP for those with both Medicaid and Medicare
- Chronic Illness SNP for those with qualifying chronic illnesses.
- Institutional SNP for those confined to a nursing home.
Medicare Drug Plans are included in all Special Needs Plans. If you are dual eligible and have both Medicaid and Medicare your co-payments will be subsidized and the Medicare Drug Plans generally do not require a monthly premium.
Although many Medicare Advantage Plans offer only Medical coverage, all SNP’s will include the Medicare Drug Plans.
Why consider one of the Medicare Plans if you have both Medicaid and Medicare?
People choose Medicare Plans for many reasons. A Medicare Advantage Plan in not considered a Medigap policy and as such the premium is usually much lower. In the case of a Dual Eligible SNP, if you have full Medicaid benefits from your State, you will generally not pay a monthly premium. You may incur a small amount in the way of cost sharing.
If you have both Medicaid and Medicare but your Medicaid benefits only allow partial benefits you may want to discuss your Medicaid status with your agent to make sure a SNP is right for you.
The benefits of choosing a Dual Eligible SNP
- If you have both Medicaid and Medicare, a SNP may allow you more benefits than what you would otherwise have. Many SNP’s include dental, vision, gym memberships (at no cost), as well as transportation benefits to and from medical appointments.
- SNP’s for those with both Medicaid and Medicare are generally network-based plans and may afford you some provider options that you otherwise may not have available.
- If you qualify you are not subject to the enrollment periods that limit most people who would like to enroll in or change Medicare Plans.
- Medicare Drug Plans are included in the SNP and you will only have to interact with one customer service department, should it be required.
This information is provided to those who may have both Medicaid and Medicare and are comparing Medicare Plans as well as Medicare Drug Plans.
You can find a wealth of information at the official Medicare website.