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Are prescription drugs covered by a Dual Special Needs plan (D-SNP)?
Posted: February 11, 2020
Last updated date: December 01, 2022
Worried about the high cost of prescription drugs? You’re not alone. Many people who rely on medicines wouldn’t be able to pay for them out of pocket. So it’s no wonder that prescription drug coverage is one of the first things people ask about dual health plans. These plans are for people who have both Medicaid and Medicare. And this article covers the prescription drug coverage that dual health plans typically include.
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Doesn’t Medicaid cover prescriptions?
That’s true. Most Medicaid plans cover some prescription drugs. But exactly which ones can change from state to state. Also, different states may have different rules for copayments and cost sharing, so not all medicines may be fully covered.
What prescriptions does Medicare cover?
Part D is the part of Medicare that helps pay for prescription drugs for Medicare beneficiaries. But this is extra coverage you don’t get with Original Medicare. The good news is that dual health plans are a type of Medicare Advantage plan, so they include Medicare Part D. That means you could get more prescription coverage than you get now with Medicaid or Original Medicare plans.
What you may have now
What you could get
How can you tell exactly what drugs are covered?
All health plans have what’s called a formulary. This is a list of drugs your health insurance or plan covers. It’s also called a preferred drug list (PDL). If you’re looking at a dual plan from UnitedHealthcare, here’s how to view a dual health plan drug list in English or Spanish:
- Enter your ZIP code in the box at the bottom of the page to find a plan in your area
- Click the “View Plan Details” box under the plan that interests you
- Select the “Drug List” in the blue provider search box to see prescriptions covered by that plan
Most likely, you’ll want to find out details about drugs you’re taking now. That’s easy to do, because you can look up an alphabetical list of any drug you’re interested in.
NOTE: Benefits vary by plan and service area. Limitations and exclusions apply.
For details about the benefits included with your Dual Special Needs Plan, call the phone number or visit the website printed on the back of your member ID card.
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Dual-eligible or Medicaid plan benefits can change depending on where you live. Search using your ZIP code to find the right plan to meet your health care needs.