Medicaid and Medicare Beneficiaries Advantage Plan Options

If you are enrolled in both Medicaid and Medicare, you are considered to be a dual eligible individual. Your health benefits are coordinated between Medicare and your State’s Medicaid program. It is important to know that, as a dual eligible individual, you have some choice when deciding on a Medicare Plan.

There are Special Needs Medicare Plans available for certain categories of individuals, including those that have both Medicaid and Medicare. A special Needs Medicare Plan is a type of Medicare Advantage Plan that is offered by a private insurance company. Insurance companies that offer Medicare Advantage Plans contract with and are approved by CMS (Centers for Medicare and Medicaid Services) to administer your Medicare Plan.

There are three types of Special Needs Plans (SNP)

Dual eligible Special Needs Plans for those with both Medicaid and Medicare
Chronic Illness Special Needs Plans for those with qualifying chronic illnesses.
Institutional Special Needs Plans for those confined to a nursing home.

Part D Medicare Drug Plans are included in all Special Needs Plans. If you are dual eligible and have both Medicaid and Medicare, your co-payments will be subsidized and the Medicare Drug Plans generally will not require a monthly premium. In general, if you are enrolled in both Medicaid and Medicare, you will not pay a premium for your Special Needs Medicare Advantage Plan.

But if you have both Medicaid and Medicare, and Medicaid only allows for partial benefits, you may want to discuss your Medicaid status with your insurance agent to make sure a special Needs Plan is right for you.

The benefits of choosing a Dual Eligible Special Needs Plan

If you have both Medicaid and Medicare, a SNP may allow you more benefits than what you would otherwise have. Many include dental, vision, gym memberships, as well as transportation benefits to and from medical appointments.
SNPs for those with both Medicaid and Medicare are generally network-based plans and may afford you some provider options that you otherwise may not have available.
If you qualify, you are not subject to the enrollment periods that limit most people who would like to enroll in or change Medicare Plans.
Part D drug plans are included in the SNP and you will only have to interact with one customer service department, should it be required.

Medicare Advantage Plans generally offer benefits beyond what original Medicare offers. As a dual eligible individual, you have the right to explore your options. Enrolling in a Special Needs Plan for people with both Medicaid and Medicare may give you more freedom of choice and some benefits you would otherwise not have available.