Dual Special Needs Plans (DSNP)
What Is A Dual Special Needs Plan (DSNP)?
If you are covered by both Medicare and Medicaid, you may be happy to learn that Medicare has approved a new type of plan for Clark County.
Dual Eligible Special Needs Plans (DSNP) are being introduced to Clark County for the 2021 year for those who have both Medicare and Medicaid. Residents can enroll during the annual Medicare enrollment period from Oct. 15 – Dec. 7, 2020.
A Dual Special Needs Plan, which is a Medicare Advantage plan provides coverage for medical and prescription drug coverage and is designed to provide additional services for those with the highest needs. These additional services are above what you could receive from an individual Medicare or Medicaid plan.
DSNP plans are provided by certain health insurance carriers through a Medicare Advantage plan. The plans use carriers’ robust network of providers and not a state Medicaid list of providers.
There are an estimated 2.6 million people enrolled in DSNP plans in 2020 throughout the United States, with the enrollees being the highest need populations in either program. Those who are eligible typically can enroll with a zero premium. There are an estimated 60,000 Clark County residents who may qualify for these plans.
There are four carriers offering a new DSNP plan for Clark County for 2021 with various additional benefit levels. One plan includes coverage of $4,000 in comprehensive dental fees, including dentures. Another plan includes a $0 co-pay on prescription drugs and offers a monthly food credit. And the plans offer coverage for vision, hearing and transportation costs.
The overall goal of DSNPs is to provide coordinated health care and services to those who can benefit the most from the special expertise of the plans’ providers and focused care management.
“These plans offer a significant improvement in access for a vulnerable population and will immediately help those who have delayed necessary care," said Mike Yasi, Advocate Health Advisors Director of National Sales for DSNP, “These special needs plans also seek to reduce overall healthcare costs by aligning carriers and providers with state-run programs as well."
Most people 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. Eligibility and levels vary by state.
About 30% of people eligible for Medicare have chosen to get their Medicare benefits through what is known as a Medicare Advantage plan, which is a plan offered by a private health insurance company approved by the federal government. Medicare Advantage plans combine a person’s Medicare benefits, including doctor and hospital coverage as well as Part D prescription drug coverage in most cases. They also can offer benefits beyond what is available with Original Medicare, such as dental, vision, hearing coverage and more.
Why would someone consider a DSNP?
DSNPs can make it much simpler for members to navigate the health care system. DSNPs encourage everyone involved – including primary care doctors, specialists, hospitals and care managers – to work together, which can help improve members’ health as well as their experience with the health care system.
DSNPs usually offer benefits, including:
- Dental care, such as exams, x-rays, cleanings, fillings, crowns and extractions and in some cases even dentures
- Access to a health products catalog to order over-the-counter products such as vitamins and first-aid supplies
- Hearing exams and access to hearing aids
- An annual eye exam and a credit for eyewear
- No-cost transportation to health care visits and pharmacies.
When can a person enroll?
The Medicare Annual Enrollment Period – Oct. 15 – Dec. 7 -- is a great time for people to review their health plan options with a licensed health insurance agent and see if they qualify for a DSNP. However, people who qualify for a dual plan can enroll or switch to a new plan at certain times throughout the year.
Contact us today to see if you are eligible for this new Dual Special Needs Plan.
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Medicare Advantage Plans are legally obliged to cover every service provided by Original Medicare, but usually, they also cover additional services.
An example is when Original Medicare will not cover much of the cost of prescription drugs unless you are in a hospital in-patient. It is possible to opt for a Medicare Advantage plan, which covers these costs.
Original Medicare comprises:
- Part A - covering hospital and nursing care
- Part B - covering doctor's visits and other medical expenses
When you have worked and paid taxes for ten years or 40 quarters, you do not pay monthly contributions to Part A Medicare.
If you only worked 30 quarters or fewer, you may contribute up to $437 per month. In any event, you are liable for a deductible of $1,364 per year.
Medicare Part B comes with monthly premiums of $135.50 and can be more for any higher earners. You can find it covers:
- Ambulance services
- Preventive medicines such as flu shots and other vaccines
- Physical therapy
- X-rays & lab tests
- Medical equipment such as wheelchairs and other aids
- Mental health care
- Chemotherapy & more
As part of the Original Medicare program, you will need to meet 20% of these services' expenses, but they can cover these through a Medicare Advantage plan with no additional out-of-pocket costs.
It still requires you to contribute monthly for Part B. Your Medicare Advantage plan can meet further services Medicare does not cover:
- Dental care and dentures
- Hearing care and hearing aids
- Nursing home care
- Health care outside the U.S.
- Emergency room visits
- Cosmetic surgery
One can also discover Medicare Advantage plans with acupuncture and chiropractic care inclusions.
Thus, depending on whichever plan you select, you may have more coverage for much less money with a Medicare Advantage plan rather than with Original Medicare. Unfortunately, you may not see the same healthcare providers. Patients from Original Medicare have the option to visit any doctor or hospital accepting Medicare. In-network service providers may only cover a patient with a Medicare Advantage plan or have to pay more for services from out-of-network services, unless in an emergency.
They will include emergency services in nationwide Medicare Advantage plans.
Costs of a Medicare Advantage Plan can be different - ranging from $0 to more than $200 per month.
Be aware, a standard cost for Medicare Part B equals $135.50 per month, so you still have to contribute this fee unless your Medicare Advantage plan covers it.
You may wonder if you can get a Medicare Advantage plan with a $0 premium?
This is possible; however, it depends on the plans available around the area; it can involve higher co-pays and deductibles than more expensive programs.
Unless you are taking prescription drugs or require frequent medical visits, you may find these plans worth consideration.
You will continue to receive protection for the maximum amount which legally may not exceed $6,700 per year and which is often significantly lower with the average of around $5,187).
As with private health insurance, Medicare Advantage contributions can vary between states.
According to the National Council on Aging, average costs are $29 for HMOs and $62 for local PPOs, with more geographical limitations.
Depending on which prescription drugs you take and coverage included, you may also incur different costs in your plan.
Las Vegas Medicare Pros help identify an appropriate plan for you by providing unbiased advice on Medicare.
While the vast majority at 65 and above will qualify for a Medicare Advantage plan, there are some restrictions when you can enroll or change your plan, so planning is probably the most important thing.
As of 2019, there are three distinct periods in which you can enroll or change plans:
- Initial Coverage Election Period - most often as you turn 65
- Open Enrollment Period - January 1st to March 31st in every year
- Fall Open Enrollment - October 15th to December 7th every year
Outside of said periods, you can only enroll or switch plans during the Special Enrollment Periods, for instance, if you lose your prescription drug coverage or leaving your employer-sponsored plan.
Suppose you develop a health condition and discover it will be cheaper to get coverage through a different plan than Medicare Advantage or Medicare Original. In that case, you cannot merely switch plans.
You would have to delay until the following application periods before applying for a new plan.
However, suppose you are eligible for Medicare Original. In that case, the Medicare Advantage plans cannot deny you an application because of pre-existing conditions except if suffering from Final Phase Renal Disease (ESRD).
However, there may be a Special Medical Needs Plan (SNP) in your region to cover ESRD.
Medicare offers two different means of obtaining prescription drug coverage. First, enroll in a Medicare Advantage Plan, including it, and second, keep the Original Medicare plus adding an independent prescription drug cover.
You may not enroll in any Medicare Advantage plan, including drug coverage and an individual prescription plan together.
The cost of your medications varies depending on your plan's co-pays and deductibles. You can also find a difference if you go to an in- or out-of-network pharmacy. Before applying, determine whether they list the medicines you require in their plan formulary, as these lists the medications they cover.
Most of the plans come in multiple levels, with increased co-pays for more expensive medications.
Your plans have to cover a minimum of 2 medications within most commonly prescribed categories and classes under Medicare. Such drugs can be branded or include generic options.
They should also inform you of any changes to the list affecting a drug you are currently prescribed.
Medigap and Medicare Advantage Plans are mutually unique; therefore, you cannot enroll in them both.
The Medicare Advantage is intended to replace the original Medicare. Medigap, by contrast, is intended to supplement it.
Medigap allows you to visit any doctor you could see with Medicare, and it will not be restricted to the HMO or PPO network. Medicap works to cover some of your out-of-pocket expenses.
Most states provide ten different Medigap plans that offer standardized benefits. In contrast to Medicare Advantage plans, they do not cover prescription drugs, dental and eye care, and other extra coverage, so you might still need to purchase a prescription plan.
Since Medigap enables you to visit any doctor accepting Medicare (may include emergency coverage abroad), Medicap may be the preferred option for elders who enjoy traveling or splitting time between two states.
Although it may not offer you the same benefits as a Medicare Advantage plan, and you may incur higher total health expenses.
Medicare Advantage plans exist for the vast majority of Americans eligible for Medicare Part A and B.
It includes seniors 65 years old and those under 65 eligible for Medicare by receiving disability payments through Social Security.
You qualify to enroll during the Initial Election Period of Coverage (ICEP), which is seven months: which includes the month you reach the age of 65, plus three months before and three months after.
For individuals under 65 receiving disability payments, you will qualify two years after starting to receive payments.
As the plans are location specific, you must also live in the service area of the plan you are claiming and must be a U.S. citizen or a permanent resident.
They cannot refuse you from pre-existing conditions except for ESRD; however, it is imperative to be sure the plan you are applying for will cover the remedies you need.
If you wish to continue consulting with your current doctor, check whether they are a part of your plan's network of providers.
Medicare Advantage plans are not appropriate for all health situations; however, there are reasons such programs may offer a better alternative than Original Medicare.
First, you can receive further benefits, like if you have a condition not covered by Medicare, such as hearing or vision loss. When you choose schemes that cover glasses or other treatments, you can save money even with monthly premiums.
Second, you may find that you have lower co-payments and lower costs. You will not need to pay the 20% co-pays required by Medicare Original. You will have a maximum out-of-pocket spending limit each year.
The Medicare Original doesn't offer out-of-pocket caps; therefore, it can cost thousands of dollars if you have an accident or a severe illness.
Third, such schemes allow you to merge your health coverage in one place.
If a plan covers vision, dentistry, and prescription drugs, you will not need to pay premiums to multiple insurance companies. Similarly, you can show the same card to each provider.
When you have an HMO plan, you may choose your primary healthcare physician, who may refer you to specialists to supervise other care.
There are some reasons, which may not suit Medicare Advantage plans, though. If you frequently travel or spending time in several states, you may find you pay more for providers outside the network.
Medicare Advantage Plans offer you emergency coverage when traveling, but usually work better for people who have all of their healthcare providers locally.