DSNP 101: Coordinated Care Can Bring Additional Benefits, Convenience to Low-Income Seniors and Peop
What’s a DSNP?
Most of us 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, though eligibility criteria vary by state.
About a third of people eligible for Medicare have opted to get their Medicare benefits through what’s known as a Medicare Advantage plan, which is a plan offered by a private health insurance company approved by the federal government.i 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 can also offer additional benefits above and beyond what’s available with Original Medicare, such as dental, vision and hearing coverage.
A Dual Special Needs Plan – or DSNP for short – is a special type of Medicare Advantage plan that provides health benefits for people who are “dually eligible,” meaning they qualify for both Medicare and Medicaid.
Anyone who meets the eligibility criteria for both Medicare and Medicaid is qualified to enroll in a DSNP. They often face unique health needs and could use assistance improving their health and quality of life. For instance they may:
Have a disabling condition and struggle with daily activities such as bathing and dressing;
Suffer from a cognitive impairment or a mental disorder;
Receive care from multiple doctors to manage a variety of health conditions; or
Be more likely to need in-home care providers or other health and social services.
More than 2 million people are enrolled in DSNPs in 2017, which represents 3 percent of all people enrolled in Medicare.ii
Why should someone consider a DSNP?
Medicare and Medicaid are important sources of health care benefits for millions of Americans, but the programs can be confusing and tough to navigate. This is especially true for people eligible for both programs. By coordinating Medicare and Medicaid benefits, DSNPs can make it simpler for members to navigate the health care system. DSNPs encourage everyone involved in caring for a member – 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 additional benefits, which can include:
Dental care, such as exams, x-rays, cleanings, fillings, crowns and extractions;
Access to a health products catalogue to order over-the-counter products such as vitamins and first-aid supplies at a discount;
Hearing exams and access to hearing aids at a reduced cost;
An annual eye exam and a credit for eyewear; and
Transportation to health care visits and the pharmacy.
And an added bonus: People who are eligible for a DSNP can usually enroll for no monthly premium, making it an affordable option.
When can people apply?
Open enrollment is a great time to consider a DSNP, as health plan benefits are often top of mind for consumers. However, people who are eligible for a DSNP can enroll or switch to a new plan at any time during the year, not just during the Open Enrollment Period.
How can someone learn more about DSNPs?
To find out if a DSNP is available in your area, you can check out the Plan Finder on Medicare.gov. After entering some personal information, the tool will show you a list of private Medicare plans available in your zip code. Check to see if any of them include “Dual Special Needs Plan” in their name.
If you’d prefer to talk to someone about your options, a trained insurance counselor through the State Health Insurance Assistance Program (SHIP) could be a great option. Or reach out to a licensed insurance agent in your area who can meet in person or over the phone to determine whether a DSNP is a good fit.
UnitedHealthcare is the largest provider of Medicare Advantage plans, including DSNPs, serving nearly 4.4 million people.iii To learn more about UnitedHealthcare’s DSNPs, call 1-844-588-5864 (8 a.m. to 8 p.m., 7 days a week, TTY 711).
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare and a contract with the State Medicaid Program. This plan is available to anyone who has both Medical Assistance from the State and Medicare.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Premiums, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. Enrollees have no out of pocket costs.
i CMS enrollment data, 2017
ii CMS enrollment data, 2017
iii UnitedHealthcare and CMS enrollment data, 2017