In 2023, more than 5 million dual-eligible individuals were enrolled in a Medicare Advantage plan designed specifically for dual-eligible people, known as Dual Eligible Special Needs Plans (DSNPs). These plans are required to provide greater coordination of Medicare and Medicaid benefits compared to other Medicare Advantage plans.

Now that you’ve enrolled in a DSNP you may be wondering what comes next. Understanding the ins and outs of your plan is crucial to making the most of your coverage, from knowing your benefits to choosing the right providers. Read on to learn more about what you need to know about your DSNP plan and how to navigate the healthcare system to maximize your benefits.

What does it mean to be dual eligible?

Medicare is a federal health insurance program primarily for people aged 65 and older, certain younger people with disabilities, and people with end-stage renal disease (ESRD). Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources.

Being dual eligible means that you qualify for both Medicare and Medicaid.

Dual-eligible individuals often have more significant healthcare needs and may have difficulty affording medical care without assistance. Medicaid can help cover costs that Medicare does not, like long-term care services, premiums, deductibles, co-insurance, and co-pays. Dual-eligible individuals also typically have access to a broader range of services compared to those who are eligible for either one program or the other.

DSNP benefits

DSNPs offer a range of benefits designed to meet the specific needs of plan members, so most include prescription drug coverage, dental, vision, and hearing care, in addition to the same hospital and medical benefits covered by Part A and Part B.

These plans also offer additional benefits like care coordination services to help manage your needs, including assistance with appointments, referrals to specialists, and help navigating the healthcare system, and programs and services to help manage chronic conditions such as education, support, and monitoring.

Many DSNPs include wellness program coverage aimed at promoting healthy behaviors and preventing illness, such as smoking cessation programs, weight management programs, and fitness classes.

And, some DSNPs even have surprising benefits like over-the-counter benefits, meal benefits, coverage for in-home support services, non-emergency transportation, and more.

What to do after enrolling in a DSNP

Review your benefits

The first step after enrolling in a DSNP should be to take time to understand the benefits offered by your plan, including coverage for medical services, prescription drugs, dental, vision, and other extra benefits. Knowing what is and isn’t covered can help you make the most informed decisions about your care.

Choose a primary care provider

Most DSNPs require you to choose a primary care provider (PCP) who will help coordinate your care. Make sure your PCP is someone you trust and feel comfortable with. Additionally, make sure the PCP is included in your plan’s provider network; otherwise, services may not be covered, and you may owe more out-of-pocket.

Understand your costs

The cost of DSNPs can vary depending on several factors such as your specific plan, your location, and your income. For example, many DSNPs have a $0 monthly premium, meaning you do not have to pay to be enrolled in the plan. However, some plans do have a monthly premium.

Like other Medicare Advantage plans, DSNPs may also have deductibles, co-pays, and co-insurance for covered services, and these costs can vary depending on the plan and services you use. Be sure to review these costs carefully.

Note that as a dual-eligible individual, you may qualify for help paying your Medicare costs through Medicaid. The exact amount of assistance will depend on your income or other factors. Be sure to review the costs and benefits of each DSNP available in your area to find one that not only meets your needs but also your budget.

Schedule a Welcome Visit

Many DSNPs offer a welcome visit with your PCP. During this visit, you can discuss your health and care needs, review medications, and make a care plan to keep you healthy.

Use the preventive services

Take advantage of preventive services covered by your DSNP, such as screenings, vaccinations, and wellness visits. These services can help you stay healthy and prevent future health problems, and catch existing problems early when they can be treated most successfully.

Take advantage of extra benefits

If your DSNP offers extra benefits like wellness programs, transportation services, meals, or others, make sure to take advantage of them. If you have questions about how you can enroll or receive these services, contact your plan.

Stay informed

Keep up to date with any changes to your DSNP coverage, including changes to benefits, costs, or providers, by reviewing your plan materials annually and contacting your plan if you have any questions.

Talk to your ClearMatch Medicare agent

If you have any questions about your coverage or benefits, don’t hesitate to reach out to your plan. Or, you can contact your ClearMatch Medicare Agent, who can help provide you with the information you need to make the most informed decisions about your health. Refer to the email from your agent for their name and phone number, and know that you have a caring, knowledgeable agent who understands your needs and is just a phone call away.

Additional Resources

ClearMatch Medicare: Find a plan
KFF.org: 10 Things to Know about DSNPs