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  • By Jeremy Farrell
  • Posted February 2, 2022

What Are Medicare Dual Special Needs Plan?

What Are Medicare Dual Special Needs Plans?

Medicare Dual Special Needs Plans (DSNP) are a special kind of health insurance plan that works as a combination type plan. These plans coordinate your health insurance needs between your States Medicaid program and Medicare to help provide you with the most value as an enrolled member. They do this by first connecting you with a case manager who acts as a point of contact and assists in helping you understand the plan and use the plan’s coverage. To put it simply, Dual Special Needs Plans are designed to be used often, for reasons we’ll discuss shortly. Because of this these plans make care very accessible and have a focus on keeping you informed and empowered to take advantage of their benefits.

How Do Medicare Dual Special Needs Plans Work?

The biggest reason that these plans exist is due to the unfortunate but very real fact that the most vulnerable individuals among us are typically the ones that get left behind in the standard plans processes of our healthcare systems. This is despite the fact that they actually need the care the most. Because this was such a big problem, there were a lot of steps taken to address it, and one of the most effective was the creation of Dual Special Needs Plans. Dual eligible’s as these individuals often called are those with low income that are eligible for Medicaid and Medicare. Insurance carriers, the Federal Government, and the Centers for Medicaid and Medicare Services (CMS) came together in an effort to offer the largest support they could to these individuals while still being able to manage the cost to both the states and federal governments spending accounts. The fact that these plans are designed to be used and used often has also been built into the way they work. They were created with the idea that if individuals aren’t afraid to get care (removing the major financial burden), they will be healthier, and this will lower the chances of needing larger more costly services. Basically, if you take care of the little things, you don’t have to deal with them piling up into something big. Through this system, the companies and government agencies actually reduce their overall costs in the long run because there are less more costly problems to deal with. During either your guardians working years your own you contributed to the Medicare programs as part of the Medicare and FICA tax. This is one of the many ways to take advantage of the programs you help fund. These DSNP’s plans are designed with very specific populations in mind, and they are full of easily overlooked but very valuable extra benefits for dual eligible individuals.

Why You Need A Medicare Dual Special Needs Plan?

When you qualify for Medicare and only use original Medicare A & B you will have fairly good coverage for a basic plan. However, there are two particular things that are worth noting about this basic plan, and these things are really what make DSNP plans so valuable. First, you are exposing yourself to potential costs. If you happen to see a doctor or facility outside of the Medicaid network, you could end up responsible for that portion of the bill and original Medicare has no limit on that amount. If a DSNP plan is available to you but you are not taking advantage of it, you have paid for or are currently paying for a level of care that you are not utilizing and are leaving money on the table. One utilization of DSNP plans that members often overlook is how they help you pay for your part of the A & B premium. In addition to your Medicaid coverage, these plans also offer a wide range of extra benefits that are not directly considered medical and go far beyond anything you’d see without a DSNP plan. This includes gym memberships, transportation (medical Rides), Dental, certain over the counter items, hearing assistance, and some newer plans are even helping with services like support dog benefits, insect extermination, home modifications for safer living, and more (these benefits vary upon where you are, but we’re happy to help you understand the options and choose the right one!) The insurance companies determined that though these benefits are not medical in nature generally it has been found that by helping with some of these other areas people stay healthier in general while promoting accessibility to healthy living within the communities by removing some of the financial barriers. These plans know that the biggest ways they can support their members and improve their quality of life are by reducing some of the physical, mental, and financial stress they are dealing with. This leads to happier people and reducing mental and financial stress and barriers is what we are all about! The way we like to think about this is that it’s a community approach to caring for your neighbors and those around you by caring for yourself!

We understand that this can still be quite overwhelming, but whether this blog post has helped you figure out exactly what you want or has just left you with further questions, don’t worry! You can contact a health insurance specialist who will do the work to find you a plan that suits your needs. Robert at Planning Across the Spectrum has helped many find the health insurance that is specifically right for them. By paying attention to what matters most Robert helps you find a plan that is mindful of your needs, your future, and current cost. We not only have the expertise, but also the passion and resources to help you achieve your financial goals your way

Contact Planning Across The Spectrum for certified special needs financial planning services and assistance with your Medicare Dual Special Needs Plan.


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