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Dual Special Needs Plans

Dual Special Needs Plans are a form of Medicare Advantage. They’re not the only type of Special Needs Plans, as there are other forms such as Chronic Special Needs Plans and Institutional Special Needs Plans. Special Needs Plans have the same general guidelines as to what is allowed.

A Dual Special Needs Plan:

  • Can allow out-of-network treatment depending on the policy available to you
  • Requires you to choose a primary care doctor
  • Requires you to get a referral from your primary care doctor in order to see a specialist

Dual Special Needs Plans include prescription drug coverage

What are some defining features of the Dual Special Needs Plans?

Dual Special Needs Plans are designed for people who qualify for both Medicare and Medicaid. For Medicare, that requires being at least 65 years of age or receiving disability benefits for at least 24 months (regardless of age).

Medicaid is based on income. You qualify if your income is determined to be low enough based on your state’s Modified Adjusted Gross Income (MAGI). You also have the option to “spend down” if you’re considered medically needy. In this case, your medical expenses will be deducted from your income, which will enable you to be eligible for Medicaid if that brings your income to a level low enough to meet the financial requirements.

Influential Factors

The following may be deciding factors in whether a person joins:

  • D-SNPs are unique in that Medicare Advantage is paired with another form of health insurance coverage (Medicaid). Typically with a Medicare Advantage Plan, having additional forms of health insurance can result in losing your Medicare Advantage policy
  • Low-cost deductibles, and in some cases, free premiums
  • Can cover additional services such as dental, vision, hearing, and even gym memberships. This can be a major deciding factor because Original Medicare does not offer coverage for these services

If you are interested in a D-SNP but are unsure if you are eligible, reach out to World Financial Solutions today.

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