Dual eligible and D-SNP plans in Baltimore
If you have both Medicare and Medicaid, you are "dual eligible." That is not a label to worry about. It means two programs are working on your behalf, and there is a type of plan built for that situation: the D-SNP, short for Dual Eligible Special Needs Plan. The mailers can make it sound like a guaranteed bargain. The truth is that it can be a great plan for the right person willing to stay within its rules.
What a D-SNP is
A D-SNP is a Medicare Advantage plan that is only open to people who have Medicare and Medicaid. Like other Advantage plans, it bundles your hospital and doctor coverage, and in most cases your drug coverage, into one plan with its own network. What makes it different is that it is designed around people with Medicaid, so many plans add services such as a care coordinator, transportation or a monthly allowance for health items.
Your costs depend on your level of Medicaid help. Some people pay little or nothing for many covered services, and others still have copays. Plans and benefits vary, and they change every year.
Who can join
To join a D-SNP you generally need Medicare Parts A and B, Medicaid, and a home address in the plan's service area. In Baltimore City that means plans offered to city residents, which are not always the same plans offered in Baltimore County next door.
Whether you qualify for Medicaid is decided by Maryland Medicaid, not by us and not by the plan. We cannot approve you or deny you. What we can do is explain what each plan offers and help you compare them.
Not every D-SNP works the same way
Plans differ in how closely they coordinate your Medicare and Medicaid. Some mainly add benefits on top of your Medicare coverage. Others work much more closely with Medicaid to manage more of your services together. Neither is automatically better. Ask each plan these questions:
- Which of my doctors participate? Network participation varies by plan.
- Is my pharmacy included? Drug coverage and pharmacies differ.
- Who is my main contact? Some plans assign a care coordinator.
- What happens if my Medicaid changes? Plans generally give a limited period to resolve it.
The tradeoffs, honestly
| Often a good fit if you | May not be the best fit if you |
|---|---|
| Want one plan and one member card for most of your care | Want to see any doctor in the country who accepts Medicare |
| Are comfortable using a plan network | Have specialists who do not participate in the plans offered to you |
| Would use extras like transportation or a health item allowance | Expect to travel often and need coverage outside the plan area |
| Would value a care coordinator | Prefer to keep Original Medicare and handle Medicaid separately |
Both paths can work. People who keep Original Medicare while on Medicaid also have options, which we explain on our page about Medicare and Medicaid together.
When you can enroll or switch
Like everyone, you can use the Annual Enrollment Period, October 15 through December 7, for coverage that starts January 1. People with Medicaid may also have extra chances to change plans during the year. Those rules have changed recently and can depend on which type of plan you are moving into, so please talk with us before you switch or drop anything. A call now can prevent a gap that is hard to fix later.
What to have ready for a call
- Your red, white and blue Medicare card and your Medicaid card
- A list of your doctors, your hospital and your pharmacy
- Your medication list with doses
- Any letters from Maryland Medicaid or your current plan
D-SNP questions we hear in Baltimore
Do I have to keep Medicaid to stay in a D-SNP?
Yes. D-SNP eligibility depends on having Medicaid. If your Medicaid status changes, tell the plan and call us right away, because plans generally allow only a limited period to sort things out.
Are all D-SNPs the same?
No. Plans differ in how closely they coordinate your Medicare and Medicaid, in their networks and in their extra benefits. Ask each plan what coordination it offers and whether your doctors participate.
Is a D-SNP right for everyone with Medicare and Medicaid?
Not always. A D-SNP can fit people who want one plan and one set of cards, and who are comfortable staying within a network. Some people prefer Original Medicare and keep their Medicaid separately. We explain both paths and the tradeoffs.
Final thoughts
A D-SNP can make life simpler, and it can also be the wrong move if your doctors are outside the network. We will walk you through the plans we represent in Baltimore City, explain the downsides, and never push you toward a plan. Results vary by person.
Let's review your Medicare coverage >>>
Call (410) 896-1212 to talk with a licensed member of our team. If you want to see how the programs that lower costs fit in, read about Extra Help and Medicare Savings Programs.
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