What Are Dual Eligible Special Needs Plans?

Millions of people around the country depend on Medicare or Medicaid to cover their medical expenses. As anyone enrolled in these programs knows, each one has its own coverage gaps and limitations. For individuals who are experiencing difficulties getting appropriate care through Medicare or Medicaid, Dual Eligible Special Needs Plans (D-SNPs) may offer the coverage they need. Here’s more about D-SNPs, the coverage they offer, and how you may be able to qualify.

How Do Dual Eligible Special Needs Plans Work?

In the most simple terms, D-SNPs are available to individuals who qualify for both Medicare and Medicaid. Dual-eligible individuals can receive their benefits through Medicare or a Medicare Advantage Plan, and Medicaid can cover their premiums while providing some benefits that Medicare doesn’t cover. While the available benefits vary by plan and by state, in Pennsylvania, a D-SNP can cover some common gaps in Medicare coverage, like dental, vision, long-term care services, and even transportation and meal benefits.

Another benefit of enrolling in a D-SNP is that they offer better coordination between Medicare and Medicaid benefits than an enrollee would experience when trying to receive benefits from each plan individually. Because navigating Medicare and Medicaid benefits can be confusing for anyone, enrolling in a D-SNP can make life simpler and provide better outcomes.

Qualifying for a Dual Eligible Special Needs Plan

Enrollment in a D-SNP is available to anyone who qualifies for both Medicare and Medicaid. You may qualify for Medicare because of your age, because of a disability, or because of certain medical conditions like end-stage renal disease or ALS.

Qualifying for Medicaid is a bit more complex because of the specific income and asset requirements needed for the program. Generally, Medicaid is intended for individuals with low income and assets, although there are some specific circumstances that would make a person eligible without financial need. If your income and assets are too high to qualify for Medicaid, it is possible to develop a “spend down” strategy that will allow you to spend your assets in a specific way until you are financially eligible. 

If you are looking to qualify for Medicaid, it’s always a good idea to speak with an attorney specializing in Medicaid asset protection so that you can ensure you are accepted into the program with your first application. Because you must spend down your assets in specific ways, any mistakes in the lead-up to your application could cause you to be rejected. When that happens, there is a waiting period before you will be allowed to apply again, which is why it is so important to get advice from a Medicaid asset protection attorney before applying.

Once you qualify for both programs, you are considered a dual-eligible individual and you can choose from any of the D-SNPs offered in Pennsylvania.

Medicaid Asset Protection Attorney in Pennsylvania

While Medicare eligibility requirements are relatively straightforward, qualifying for Medicaid is much more complicated. That’s why it pays to have the advice of an experienced Medicaid asset protection attorney well before you apply. An attorney can give you valuable advice on how to spend down your assets while receiving the most possible benefit from them. Furthermore, an attorney can assist you in navigating the application process.

Attorney Robert Slutsky has spent decades advising Pennsylvania seniors and persons with a disability on the best way to qualify for Medicaid. Rob is well-equipped to help you ensure a successful application on the first try. At Slutsky Elder Law, we know that many people are counting on receiving government benefits in order to cover their medical expenses, which is why we work hard to give you the best advice. If you’re not sure whether or not you are a dual-eligible individual, it makes sense to speak with an attorney. Don’t miss out on valuable benefits for dual-eligible individuals; take advantage of a trusted Medicaid asset protection planning lawyer in Delaware County, PA and surrounding counties by calling (610) 940-0650 or contacting us to request a consultation. 

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