Dual Eligible Special Needs Plans (D-SNP) FAQ

A dual special needs plan is a type of health insurance plan. It’s for people who have both Medicaid and Medicare. If that’s you, you’re “dual-eligible.” (That’s just another way of saying you can have Medicaid and Medicare at the same time).

What makes this a plan for people who are dual-eligible?

Dual special needs plans are for people who could use some extra help. That may be because of income, disabilities, age and/or health conditions. Dual plans are a type of Medicare Advantage plan. Dual special needs plans are also called D-SNP for short. These names all mean the same thing. 

How does it work if you’re dual-eligible both Medicaid and Medicare?

A dual special needs plan works together with your Medicaid health plan. You’ll keep all your Medicaid benefits. Most dual plans also give you more benefits and features than you get with Original Medicare. All for a $0 plan premium.

Medicare is a national health insurance program run by the federal government. It’s for people age 65 and older, and also some people under age 65 with certain disabilities. Medicaid is a joint program that states and the federal government fund together. Millions of people get health coverage through their state Medicaid program. Children, pregnant women, elderly adults and people with disabilities, as well as eligible low-income adults are typically covered by Medicaid.

Yes. Some people receive benefits from both Medicare and Medicaid. These people are “dual eligible.” They qualify for Medicare because of age (they’re age 65 or older) or due to having a disability. They’re also eligible for Medicaid because they meet the requirements to qualify for Medicaid in their state.

For details about the dual plans we offer in your area, please visit UHCCommunityPlan.com.

People who qualify for both Medicare and Medicaid at the same time are “dual eligible.” They are “dual eligible” for both health care programs.

Medicaid health care programs are managed by each state government. But the state government itself doesn’t provide health insurance. Each state government contracts with private insurance companies like UnitedHealthcare. These companies provide health coverage for people who qualify for Medicaid and other government health care programs. UnitedHealthcare Community Plan is the brand name for the government-sponsored health plans operated by UnitedHealthcare.

To apply for Medicaid, you’ll need to submit an application to the agency that manages the Medicaid program in your state. You can find out about Medicaid plans UnitedHealthcare Community Plan offers in your area on our website at UHCCommunityPlan.com.

When you apply for Medicaid, you’ll need to fill out an application form. Different states have different requirements for Medicaid. You’ll likely need to have various documents, such as:

Personal information

• Information about household members (name, date of birth and Social Security number)
• Proof of citizenship

Financial information

• Rent or mortgage information
• Expenses (utilities, daycare, etc.)
• Vehicle information
• Bank statements
• Income (pay stubs)

Medical information

• Proof of disability or medical records showing a lasting medical condition
• Recent medical bills

For details about the dual plans we offer in your area, please visit UHCCommunityPlan.com.

All state Medicaid programs cover low-income people who qualify, including families and children, pregnant women, the elderly and people with disabilities. Some state Medicaid programs cover all low-income adults who earn less than a set income level.

For details about the dual plans we offer in your area, please visit UHCCommunityPlan.com.

The exact requirements to qualify for Medicaid depend on where you live. To find out if you're eligible for Medicaid in your state, go to UHCCommunityPlan.com. See what Medicaid plans we offer in your area and check the eligibility requirements.

Medicaid programs often cover benefits that aren’t offered by Medicare. Examples could include dental, vision and hearing coverage, transportation assistance and long-term care. Paying for certain Medicare costs is another way Medicaid programs can help Medicare.

The overall goal is for both Medicaid and Medicare to work together more effectively to improve care and lower costs. It’s the responsibility of the Medicare-Medicaid Coordination Office to make sure that people who are dually enrolled in both Medicare and Medicaid have full access to seamless, high quality health care. The Medicare-Medicaid Coordination Office was created within the Centers for Medicare & Medicaid Services (CMS) as part of the Affordable Care Act.

Medicare and Medicaid are two separate programs that have different eligibility requirements.

To qualify for Medicare, you need to be:

• At least 65 years old, or under 65 and qualify on the basis of disability or other special situations.

AND

• A U.S. citizen or a legal resident who has lived in the U.S. for at least 5 years in a row.

To qualify for state Medicaid benefits, you need to be:

• Under age 65 and meet the requirements for low-income families, pregnant women and children, individuals receiving Supplemental Security Income (SSI), disability or other special situation.
• At least 65 years old and you also:
  • Receive Extra Help or assistance from your state.
  • Are blind or have a disability, but do not need long-term care.