Understanding Dual-SNPs
What is all the fuss about?
Insurance carriers do a lot of advertising around Dual Special Needs Plans. Chances are good you’ve either seen their ads on TV or have been bombarded with mail about these products. So today we’re going to get into what a Dual plan is, common misconceptions and the benefits they can provide.
A Dual-SNP is a special type of Medicare Advantage plan designed specifically for people who have both Medicare and Medicaid (also known as Forward Health or BadgerCare here in Wisconsin). You are required to have both in order to be eligible. Like regular Medicare Advantage plans, a Dual-SNP becomes your primary Medicare insurance and provides your Medicare Part A and Part B benefits. These plans always include your Part D prescription drug coverage and are LOADED with extra benefits – dental, vision, credits for everyday over-the-counter items to name a few. Since this plan is designed for someone on an extremely limited income the monthly premium for a Dual plan is always $0 for people who qualify for the federal extra help program. Let’s take a deeper dive into how they work.
In order to understand how a Dual plan works we first need to understand how original Medicare, Medicaid and Part D coordinate. A lot of people think that once you’re eligible for Medicare you no longer qualify for Medicaid. At this point, hopefully you’ve learned that that isn’t the case. When you’re only on Medicaid, it pays your hospital, medical and prescription drug costs (you still may have a small copay depending on the level of assistance you receive). Once you qualify for Medicare – by either turning 65 or through the basis of disability – the structure of who pays for your healthcare costs changes. Medicaid is no longer the primary payer of your costs, Medicare is. In addition, Medicaid no longer pays for your Medicare eligible prescription drugs either. So here’s what the structure looks like:
- Medicare is primary and pays its normal share
- Medicaid is secondary to Medicare and picks up the deductibles and 20% coinsurance that Medicare would typically leave you responsible for
- Your prescription drug coverage is now under Medicare Part D instead of Medicaid
Keep in mind Medicare Part D is not a part of Original Medicare and is only available through private insurance companies. Medicare will automatically enroll you into a Part D plan unless you are proactive and enroll into one yourself. With so many moving pieces it’s easy to see why there is so much confusion and misinformation about how it all works and who pays for what!
Part D
Prescription Drug Coverage
Now you’re probably wondering how a Dual plan fits into all of this and maybe even concerned that it’s going to make it even more difficult to navigate. Thankfully, it’s not. A Dual-SNP is only available through private insurance companies. Here’s what the structure looks like for someone with a Dual plan:
- Your Dual plan is your primary insurance and provides your Medicare Part A, Part B and Part D prescription drug benefits
- Medicaid is secondary to your Dual plan and picks up the deductibles and 20% coinsurance that you would typically be responsible for
Since it combines your Part D with the Dual plan it makes your healthcare a little less complex – not to mention cuts down on the number of insurance ID cards you have to carry around with you! Okay, so other than making your insurance a little easier to understand, why would you want to enroll into a Dual plan?
Dual-SNP
Includes Parts A, B & D
Dual plans give you benefits that are above and beyond what you already receive with your Medicare and Medicaid – notice I didn’t say instead of your Medicare and Medicaid (more on this later). There are several advantages to being in a Dual-SNP. The following isn’t a comprehensive list and benefits vary based on your service area so please consult with a licensed agent to obtain a full list of the benefits available. Common benefits include:
- Routine and comprehensive dental
- Vision and credit for glasses or contacts
- Hearing exams and hearing aids
- gym memberships and activity trackers
- Over-the-counter credits for everyday health items
- Personal emergency response systems
- Mail-order prescription programs
- Worldwide emergency coverage
- ***disclaimer: these benefits vary by service area. Please consult with a licensed agent to determine which benefits are available in your area
In Sheboygan county, where I live, the total amount of these extra benefits exceeds $5,000 every year! Imagine being able to get a good pair of glasses and lenses instead of being forced to pick out of the special tray they show you; or having the ability to get dentures and access to more dentists; or getting your vitamins, bandages, hand sanitizer, joint supports, diabetic compression socks and more without having to spend any of your limited income on them? Can you see how a person’s quality of life could be drastically improved? Out of all the business our agency conducts, about 75% of it is dedicated to helping people who have Medicare and Medicaid better understand how their insurance works and making sure they’re receiving all the benefits they’re eligible for.
There are even more benefits to being in a Dual plan that you’re not going to be able to see by simply comparing benefits of different plans. For instance, you have the ability to choose to have your Medicare, Medicaid and prescription drug coverage administered by the same company. In most cases this doesn’t necessarily enhance any of the extra benefits on the front end – rather it decreases the number of billing issues on the back end. For example, if you or someone you know is on Medicare and Medicaid, think of a time when you received a bill in the mail from your provider’s office that was supposed to be paid for by the insurance company. Most often this usually isn’t because your insurance didn’t cover it but simply because the provider billed your insurance incorrectly. Remember, Medicare (or Medicare Advantage) is primary and Medicaid is secondary. The reason you got that bill is typically because they didn’t realize you had a secondary insurance, or they thought your Medicare Plan oversaw both Medicare and Medicaid. When you have both administered by the same company there are fewer issues because the billing office is sending everything to the same insurance carrier and the different departments can communicate with one another much easier. Not to say you won’t ever have issues – the frequency is just much lower.
Earlier, I mentioned Dual plans provide you benefits in addition to your Medicare and Medicaid – not instead of them. The most common misconception I come across, from potential clients and trusted professionals alike, is that if you enroll into a Dual plan then you’re going to lose your Medicaid benefits. Don’t get me wrong, I don’t think anyone is intentionally misleading you – in fact most probably have your best interests in mind. However, unless your case worker, pharmacist, friend, etc. happens to hold a health insurance license and is experienced with Medicare and Medicaid health insurance, they shouldn’t be giving you advice or recommendations about it. With that said, there are steps you want to take with a licensed agent to make sure you’re a good fit for a Dual plan. Including verifying your level of eligibility for a Dual plan, checking the status of your providers, reviewing your prescriptions and ensuring you have a clear understanding of the benefits so that you get what you’re expecting. Your agent will be sure to do all of this for you and will continue to be a resource anytime you have questions down the road.
Our main goal at Patch Adams & Associates is to educate our communities on how their insurance works, ensure they’re in the most cost-effective plan for their needs and ensure they’re receiving all the benefits they’re eligible for. You should now have a much better understanding about how Dual plans work, common benefits and misconceptions and what to look into before you enroll. If you have more questions or want to see if a Dual plan is good for you simply contact your agent or reach out to us below. We’ll be right here doing what’s right.
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By providing the information above I grant permission for a licensed sales agent to contact me via phone or email regarding Medicare Advantage Plans, Medicare Supplement Insurance, and Medicare Part D Prescription Drug Plans.