| Tue, Nov 14, 2017 @ 09:00 AM

Medicare DSNPs Serve Low-Income Seniors and People With Disabilities

Posted by Medicare Made Clear

senior couple sitting playing cardsAs you’re enjoying the splendid fall season and pumpkin-spice everything, don’t forget that autumn also means open enrollment for health insurance. And if you’re eligible for both Medicare and Medicaid, you should know about an option that could offer a convenient, affordable approach to managing your health care.

What’s a DSNP?

Most of us have heard of Medicare and Medicaid. Medicare provides health benefits for people over age 65 as well as people younger than 65 who qualify due to a disability. Medicaid provides health benefits for people with low income, though eligibility criteria vary by state.

About a third of people eligible for Medicare have opted to get their Medicare benefits through what’s known as a Medicare Advantage plan (Part C).1 Plans are offered by private health insurance companies approved by the federal government. Medicare Advantage plans combine doctor and hospital coverage in one plan and most include Part D prescription drug coverage as well. They can also offer additional benefits above and beyond what’s covered by Original Medicare (Parts A and B), such as dental, vision and hearing coverage.

A Dual Special Needs Plan – or DSNP for short – is a special type of Medicare Advantage plan that provides health benefits for people who are “dually eligible,” meaning they qualify for both Medicare and Medicaid.

Who qualifies?

Anyone who meets the eligibility criteria for both Medicare and Medicaid is qualified to enroll in a DSNP. These individuals often face unique health needs and could use assistance improving their health and quality of life. For instance they may:

  • Have a disabling condition and struggle with daily activities such as bathing and dressing
  • Suffer from a cognitive impairment or a mental disorder
  • Receive care from multiple doctors to manage a variety of health conditions
  • Be more likely to need in-home care providers or other health and social services

More than 2 million people are enrolled in DSNPs in 2017, which represents 3 percent of all people enrolled in Medicare.1

Why should someone consider a DSNP?

Medicare and Medicaid are important sources of health care benefits for millions of Americans, but the programs can be confusing and tough to navigate. This is especially true for people eligible for both programs. By coordinating Medicare and Medicaid benefits, DSNPs can make it simpler for people to navigate the health care system.

DSNPs encourage everyone involved in providing care – including primary care doctors, specialists, hospitals and care managers – to work together, which can help improve health as well as the health care experience.

DSNPs usually offer additional benefits, which may include:

  • Dental care, such as exams, x-rays, cleanings, fillings, crowns and extractions
  • Access to a health products catalogue to order over-the-counter products such as vitamins and first-aid supplies at a discount
  • Hearing exams and access to hearing aids at a reduced cost
  • An annual eye exam and a credit for eyewear
  • Transportation to health care visits and the pharmacy

And an added bonus: People who are eligible for a DSNP can usually enroll for no monthly premium, making it an affordable option.

When can people apply?

Medicare Open Enrollment is a great time to consider a DSNP, as health plan benefits are often top of mind for consumers. However, people who are eligible for a DSNP can join or switch to a new plan at any time during the year, not just during open enrollment.

How can someone learn more about DSNPs?

To find out if a DSNP is available in your area, you can check out the Plan Finder on Medicare.gov. After entering some personal information, the tool will show you a list of private Medicare plans available in your zip code. Check to see if any of them include “Dual Special Needs Plan” in their name.

If you’d prefer to talk to someone about your options, a trained insurance counselor through the State Health Insurance Assistance Program (SHIP) could be a great option. You can find the number to call in your state at shiptacenter.org. Or reach out to a licensed insurance agent in your area who can meet in person or over the phone to help determine whether a DSNP is a good fit for your needs.

Related content

What’s the Difference Between Medicare and Medicaid?

Medicare Basics for Caregivers

Concrete Answers to 10 Common Medicare Questions

For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.

CMS enrollment data, 2017



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