DSNP 101: Coordinated care can bring additional benefits, convenience to low-income seniors and people with disabilities
As you’re enjoying the splendid fall colors and pumpkin-spice everything, don’t forget that autumn also means open enrollment for health insurance. And if you’re eligible for both Medicare and Medicaid, you should know about an option that could offer a new, convenient approach to managing your health care.
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 government1. 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.
Who qualifies?
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
- Be more likely to need in-home care providers or other health and social services
More than 2.6 million people are enrolled in DSNPs in 2020, which represents 9.5% of all people enrolled in Medicare.1
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
- No-cost 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 to enroll?
The Medicare Annual Enrollment Period is a great time for people to consider their health plan options and see if they qualify for a dual plan. However, people who qualify for a dual plan can enroll or switch to a new plan at certain times throughout the year, not just during the Annual Enrollment Period.
To learn more visit UnitedHealthcare’s dual health plans or call 1-855-799-3199, TTY 711.
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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 6.4 million people.2 To learn more about UnitedHealthcare’s DSNPs, visit our DSNP plan page, call 1-844-588-5864 (8 a.m. to 8 p.m., 7 days a week, TTY 711).
