Dual Eligables, Chronic Illness, Medicaid

This type of plan is a Medicare Advantage Plan allows patients to receive care through a network of providers that contract with Medicare for Special Needs. These plans serve individuals with chronic or disabling conditions. In order to get additional Advantage Special Needs benifits, you must have a medically necessary and documented disability. Eligible patients receive care and services from doctors or hospitals in their  Advantage special needs networks.

To be eligible for a special needs plan, an individual must fit into one of the following groups. People who live in certain institutions like nursing homes or who require nursing care at home or facility based care or home and community based care, and people who are eligible for both Medicare and Medicaid. 

For example, eligible people who have specific chronic or disabling conditions like diabetes, End-Stage Renal Disease, HIV/AIDS, chronic or congestive heart failure, dementia or other disabilities. Eligibility is reviewed for income, assets, and qualifying health conditions on a yearly basis.

Special needs plans have additional benefits in addition to an Advantage plan

Patients may not need other forms of health insurance to be fully covered. Persons with Medicare and Medicaid or with limited income may pay little to none of their own money for services. Networks or providers may not be available in all parts of the country. Each year, networks can choose to leave Medicare, meaning the people they serve will need to find a new network to cover them.

What are some of the benefits of a special needs plan

These are just a handful of examples of the extra benefits of Dual Eligible Special Needs Plans and typically include Part D, dental, vision, hearing coverage, meals, care coordination via a personal care coordinator, personal emergency response system, tele-health options such as virtual medical visits with your doctor, credits to buy health products, plus transportation assistance and more. Each plan is different, so be sure to look at what's available where you live by zip code and county.

Special Needs eligibility and medication coverage in 2024

If you have limited income and resources, you may qualify for a low-income-subsidy to cover all or part of the Part D premium and copays. Eligibility is based on income that does not exceed $21,870 individual or $29,580 a couple and resources that do not exceed $15,160 individual or $30,240 a couple.

Dual Eligible means you have a Medicare and Medicaid policy at the same time. If you are struggling with the high cost of drugs, contact me and I can walk you through the eligibility process for $0 deductible and no copays for the following three programs.