Have Medicare and Medicaid? A doctor explains 5 things to know about Dual Special Needs plans

Sponsored by UnitedHealthcare

For people juggling multiple health needs, visiting different doctors, or managing both Medicare and Medicaid coverage, understanding how the healthcare system works together can be complicated, whether you're managing your own care or helping a loved one.

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

Here, she answers common questions about Dual Special Needs Plans and how they may help bring your coverage and care together to support your health.

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

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

D-SNPs coordinate Medicare coverage with Medicaid benefits, which individuals continue to receive as long as they remain eligible. Depending on the plan and eligibility, a D-SNP may offer $0 monthly premiums.

2. Why can care coordination be helpful for people managing multiple health needs?

Dr. Allen: When you're managing multiple 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 offer care coordination to help you understand your coverage, find in-network doctors and hospitals, track 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's health needs and treatment goals are different. A D-SNP may help develop an individual care plan with you and your care team based on your medical, emotional and social needs and treatment goals.

This care plan may include help staying on top of preventive care. Annual wellness visits and recommended screenings may help identify health concerns earlier.

A D-SNP may also help 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 things can affect your overall health, including your diet and nutrition, keeping up with dental, vision and hearing care, and even being able to get to doctor's appointments.

Depending on the plan and your eligibility, some D-SNPs may offer additional benefits that can help with certain everyday needs and expenses, including healthy food and certain 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 additional eligibility requirements, so 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 you or your loved one's eligibility and health needs, 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.

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