Medicare Advantage Special Needs Plans for Dual-Eligible Individuals
If you are covered by Medicare and receive some form of Medicaid benefit, you are considered “dual eligible”, and may qualify for a Medicare Advantage plan specifically designed to meet your needs.
Plan availability varies depending upon your residence. This plan offer Special Needs Medicare Advantage plans that provide full Medicare health care coverage, prescription drugs, plus additional benefits and services for people who are eligible for both Medicare and Medicaid.
These plans offer more benefits and services than Original Medicare, helping you to receive more personalized care and attention. These plans are designed to work with your existing state coverage.
Coverage for People with Limited Income
This plan provides coverage for people enrolled in Medicare and who are enrolled in Medicaid (or “dual eligible” and receive assistance from the state for their health coverage).
These plans have benefits geared to people living in community settings and are designed to help them receive the preventive care they need, including coverage for hospital and shorter-term nursing home stays. Here’s are some of the benefits of this plan:
- Includes a built-in prescription drug coverage (Part D) often at no additional premium if you are receiving the Low Income Subsidy (LIS) because of your Medicaid coverage
- Provides additional benefits, like preventive care, that Original Medicare doesn’t cover
- No medical copayments or cost-sharing if you are receiving Full Medicaid Benefits
- Keep your existing Medicaid benefits
- Access to care management support
Who is Eligible for These Plans?
To enroll in Special Needs plan you must meet the plan’s specific eligibility requirements. pecifically, you must qualify for both Medicare and Medicaid (also referred to as “dual eligible”)
* In a Dual Eligible Special Needs plan, the premiums, copayments, coinsurance and deductibles may vary based on your income and Medicaid status. Please contact us for specific details.
Because of the Medicare needs of someone in an assisted living facility, individuals can join this Health Plan all year long. These plans provide a flexibility that other plans do not have. For quotes and assistance with enrollment, contact Medi Gap Advisors at 800-913-3416 or click here to request a free telephone consultation.
Make Sure Your Doctor is On The List
Before signing up for this Medicare Advantage plan, you want to be sure that there are enough doctors in your area who accept the plan. Contact us, and we’ll be happy to see what plans are available that your physician accepts, or to review the general availability of doctors in your area.
Search the drug list
A formulary, or drug list, is a list of prescription medications that are covered under a health plan that offers prescription drug (Part D) coverage.
A formulary or drug list is a list of prescription drugs covered by your Medicare Part D plan. This list of covered medications can help you and your physician maximize your plan benefits while minimizing your overall prescription drug costs. A formulary makes it easier for your physician to select a medication that will be covered by your plan. This means you will be able to obtain your medicine at your pharmacy of choice more quickly. You will want to carefully weigh the differences in drug lists against the plan costs and other features when choosing a plan that may best meet your needs.
Generic drugs: The drug formulary covers both brand-name and generic drugs. A generic drug typically is less expensive and is sold under a generic name for that drug (usually its chemical name). Because generic drugs are less expensive than their brand-name equivalent, your copayment usually is less, as well.
Coverage limitations: To be covered, drugs must be prescribed for a use that is Approved by the FDA or documented in at least one of the specific peer-review compendia identified by the Centers for Medicare and Medicaid Services (CMS). The most popular Dual-Eligible plans we offer are with UnitedHealthcare. You can find out if any additional coverage limitations apply to the coverage of your drug by reviewing the Formulary (Covered Drugs List). Prior authorization requires you or your doctor to get approval from the plan before your drug is covered.
Coverage determination and exceptions: A coverage determination is a decision made by your plan regarding payment for a drug or the types of drugs covered as part of your benefit. If you wish to have the plan review its coverage decision based on your individual circumstances, you may request an exception to a coverage determination.
Getting Quotes and Signing
For quotes and assistance with enrollment, click here to request a free telephone consultation.