Medicaid & Medicare: Dual Eligibility Plans (DSNP)
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- เผยแพร่เมื่อ 28 พ.ค. 2024
- If you can't afford health insurance and meet certain criteria, you may be eligible for both Medicaid and Medicare. These types of plans are known as Dual-Eligibility Special Needs Plans (DSNP's) and are a type of Medicare Advantage Plan (Medicare Part C) But what type of healthcare do the Dual Eligibility Special Needs Plans offer? How much will it cost? Are you eligible for both Medicaid and Medicare? Watch this video or give us a call today! At iHealthBrokers we are licensed nationwide and our services are 100% FREE! Call us at (888) 410-0344.
This video will answer Medicaid/Medicare Questions such as:
1. What benefits are covered by a DSNP? Is it the same as Medicare Advantage (Medicare Part C) and Medicaid?
2. When is enrollment? When is Medicaid enrollment? When is Medicare enrollment? How do I enroll in a dual-eligibility special needs plan?
3. Am I eligible? What are the criteria for Medicaid Eligibility? What are the criteria for Medicare Eligibility?
4. How do my disability benefits or social security benefits affect my Medicaid & Medicare Eligibility?
5. Are there different types of Dual Special Needs Plans? How do I choose the best Medicaid/Medicare Plan?
6. How to Sign Up at Age 65 (or Under)
7. Medicare vs Medicaid: What are the differences and similarities?
8. How do DSNP's relate to Medicare Part A, Medicare Part B, & Medicare Part D?
9. And More!
Even if a DSNP is not an option for you, there may be other more financially feasible health insurance possibilities (Lowering you Premiums on Medicare Part D, cost saving plans with Medicare Part D, Medicare Part C or Medigap/Medicare Supplement Plans) We can help walk you through the enrollment process and our services are 100% FREE!
Give us a call at (888) 410-0344 or visit us online at iHealthBrokers.com.
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I am glad to finally find videos going over this for us who are lower incomes and possibly disabled where most just cover advantage and supplemental insurances which helps us not at all!
So glad to be of help, Eve!
I hate this! Its all WAY to confusing especially for us seniors 😢. Im currently on Medicaid and wish it could stay that simple when i turn 65 next year. This is one reason why I refuse to go to any doctors or Healthcare facilities. I can barely afford rent let alone any insurance coverages.
Oh no. I'm so sorry. It should not be that way. If you need help, please feel free to give us a call at 888-410-0344. There is no charge for our services and we will try to walk you through everything and answer your questions. Best of luck!
Hey I found your vídeo about muy cuestión. Thank you so much.
With dual plans that are HMO are co pays and co insurance covered for out of network providers.
Hi Bobby. For HMOs, you only have coverage in network (except in the case of a true medical emergency). PPOs will offer coverage in and out of network. Thanks for your question!
Oh yes you are ok with Illinois I just heard.
We are licensed nationwide 🙂
Which type of dual advantage plans includes a flex type card that cvovers food? My son is single and a veteran; he had his SNAP benefit cut to 24$, what is his best option?
Is he also eligible for Medicare? DSNPs are a type of Medicare Advantage Plan so they vary from carrier to carrier and location to location. Feel free to call us at 888-410-0344 to discuss the options available. Thanks for your question!
Question! My dad has Medicare and Medicaid and he's looking at a DSNP plan. He also has extra help program. So if he enrolls in the DSNP, does all his copays for RX drugs drop to zero, per the plan? Assuming they are covered of course. I'm a little confused. I was told he pays $1.35 for generics and $4 for brand names. Will that become zero for both? Thanks!
Great question! The Extra Help program works with Medicare Part D. If you have a DSNP, you do not need Medicare Part D because your prescriptions will be covered under your DSNP. Prescription copays will likely be quite low on a DSNP, but we'd need to look at the specific drugs and plan to get an idea of costs. If you'd like, you or your father can call us at 888-410-0344. You may also be able to get a better idea by looking up your prescription and plan on Medicare.gov, but the tool isn't perfect.
what a sales pitch - the brokers that have contacted me have not really shown any interest in learning about my specific needs, they just push their preferred product....
Hello there. Not sure what "brokers" you have spoken to, but we're sorry that you've had a bad a bad experience. Also, we never contact anyone unsolicited. Additionally, we do not have a preferred product. Feel free to check out our reviews. Have a great day!
Thank you for this 🙏💯
Glad we could help!
Are there assets requirements for medicaid? Examples would be IRAs, savings accounts etc. For income requirements do they go by gross or AGI? Thanks for your input.
There are definitely income and asset requirements for Medicaid and they can be pretty stringent. Unfortunately, for the exact details, you'd have to speak with someone from Medicaid because they can vary. With marketplace plans, they look at MAGI, so it may be the same with Medicaid.
Yes, there are asset/resource requirements, especially for Medicaid for the Aged (65+ years old), Blind, and Disabled (on SSI or SSDI). This type of Medicaid is often referred to as ABD Medicaid. In many states, the ABD Medicaid uses the SSI resource threshold of $2000 for an individual or $3000 for a couple. They may even use the SSI resource criteria for determining countable resources (because not all resources count). IRA's, savings accounts, investments, even whole life insurance policies (which have a cash surrender value), usually count as a resource. One home and one personal vehicle are often excluded from being counted as a resource. But some states add stricter resource requirements than the what the SSI criteria offers.
ABD Medicaid often has stricter income requirements than the MAGI groups (e.g. other types of Medicaid) or the Health Insurance Marketplace. For example, ABD Medicaid in Virginia includes in its income calculations: worker's compensation, gifts and inheritances, certain Veteran's benefits, child support payments, and life insurance proceeds. But it's likely because these forms of income are also considered for SSI.
Not only are these income and resource limits for ABD Medicaid are usually slightly different from state-to-state...the resource exclusions and income deductions and exclusions might also be different. So talking to Medicaid or other agencies in your state that understand and communicate these criteria to you would be your best bet for figuring things out.
Thank you. Beautiful. I keep hearing Medicare advantage plans are just horrible. Horrible. So this is maybe not great even if you are eligible. I am on Medicaid plan now transitioning to Medicare in a few months. I think the DSNP plans are risky. No? I might call you as well, are you licensed in Illinois. Thanks.
Medicare Advantage plans can definitely be risky. Most people opt for Medigap instead, but it depends on your health needs and your finances. Please feel free to give us a call. We can discuss the pros and cons specific to your situation and point you in the right direction. 888-410-344.
Are Medicare saving programs (QMB, SLMB, QL , QDWL) will pay the premium to the traditional Medicare, to help the individual who are below FPL?
Yes! Different programs has different benefits and different criteria, but they will help pay for your premiums. We have a video for Medicare Savings Programs which explains everything: th-cam.com/video/MQL7p-g3u7I/w-d-xo.html
good to see here bro
I’m on Medicaid in Arizona for the last 10 years. I just turned 65 and applied and now have Medicare. Can I also get a supplement G plan too?
You can absolutely still apply for Supplement Plan G. Please feel free to give us a call at 888-410-0344 and we can walk you through your options. If you are eligible for Medicaid and Medicare then you may want to look into a DSNP for the most bang for your buck. Thanks for your question!
Plain A and B has no cap. If you face any real event. Ask about limitations that could happen. In 2011 I believe they put a individual cap per person on Medicare Advantage plans.
It’s very scary. But plain Part A, Oart B might initially look great. There is a$1000 dollar charge for each hospital visit, if u are discharged and then they re admit you, if there is a secondary reason Medicare will push those charges for you to pay saying” You present w a secondary issue”
Really we must all educate ourselves as to how the health system works?
Bless you.
I’ve worked over 40 yrs in a lg hospital. Medicare is not thr best
If you are cost share protected with full Medicaid in AZ, and your doctors work with and accept it, you should get a Dual Eligible Special Needs Advantage plan
If I already had fidelis medicaid and became eligible for medicare A + B do I have to accept B if I'm already covered with no premiums?
This video is about DSNP's which are a type of Medicare Part C (Medicare Advantage Plan). These plans replace Original Medicare (Part A & B) and are entirely optional. That being said, you can always defer or refuse Medicare Part B if you so choose. When you receive your card in the mail, just follow the instructions on the back of the card and send it back to make sure you're not charged.
So I will be receiving Extra Help with prescription cost and medicaid. Should I stay with Regular Medicare and a part D or Get a medicare advantage. Or will I not need a Medicare Advantage plan while I have duel medicare/Medicaid?
Oh, this is a tough one. Have you looked into Medicare Savings Programs by any chance? If you are eligible for Medicaid, you may also we eligible for a Medicare Savings Program.... Please call us at 888-410-344. We can look at all of the plans available to you in your area to figure out what would work best.
Hello. Which states give the most Medicaid and Medicare Savings Program QMB to help poor people pay for what Medicare doesnt? Thanks.
You may want to check out this DSNP map: www.macpac.gov/subtopic/medicare-advantage-dual-eligible-special-needs-plans-aligned-with-medicaid-managed-long-term-services-and-supports/ The areas in gray do NOT offer DNSPs. Thanks for your question!
What if there is no DSNP plans available in my area but I have full Medicaid benefits, Am I able to enroll in a regular MAPD Plan?
You can still enroll in a Medicare Advantage Plan, if there are no DSNPs in your area that will meet your needs. You could also look into Medicare Savings Plans. You can learn more here: th-cam.com/video/MQL7p-g3u7I/w-d-xo.html
I have been on ssi for 24 months and was told by social security that I was not eligible for medicare. I don't understand. I live in Florida
Hi Calvin, please give us a call at 888-410-0344 and we'll try to help.
Hi my husband is recieving part A and B and he is under medicaid coverage. Is it necessary that he need to have have part D?? If a income of monthly social security.
To clarify, he has Medicaid and Original Medicare, correct? Although Medicaid is somewhat federally regulated, states make many decisions regarding medicaid individually. So, I would contact your state's medicaid phone number to determine whether you have adequate prescription drug coverage. If so, then your husband would probably not need Part D.
Will a state paid Medicare pay the co-pays I have already paid since I started it?
Richard , many states Medicaid programs can pay bills for up to 90 days prior to your approval date. I would follow up with your local office to confirm if this is available in your state.
I have medicaid. I have been in a nursing home for 6-years. I was mailed a Medicare card. Am I required to pay anything? I cannot.
There is a charge for Medicare Part B based on your income and there can be a charge for Medicare Part A based on yours and/or your spouse's work history. You have a few options: 1) Enroll in a DSNP. DSNPs will have a very low monthly charge and will offer you the benefits of Medicare AND Medicaid. 2) Enroll in a Medicare Savings Program. These are programs available to people with very limited income and assets that can offer Medicare at very discounted costs. 3) Follow the instructions on the back of the card and send it back to unenroll in Medicare so that you will not be responsible for the charges. Please feel free to contact us at 888-410-0344 to discuss your options. Thanks for your question!
Can a provider bill a patient that has a DSNP if they are out of network with Medicaid but in network with Medicare? Or can the patient opt to pay out of pocket?
Heidi,
Thank you for your question. Your network on a DSNP plan is determined by your DNSP insurance carrier. If the provider is in-network for your DSNP plan, then you are covered.
U can go and apply for qmb it PAYS ALL of your Medicare premiums for you I have United Healthcare and since I make below a certain amount of money apply for qmb through Medicare and it pays all of my medicare premiums for me it also pay extra for medication pay for Doctor co-pays I have United Healthcare Medicare Advantage plan has dental vision hearing aids I can see any doctor I want in and out of network I can see any specialist without a co-pay and without a doctor referral it has dental and vision will $350 of eyeglass every year or I should say every two years free trips to and from a doctor all for the 0 premium
@@eugeneallison7457 Thank you for this excellent comment. Based on this, we will produce a video specifically on the numerous Medicare Savings Programs that are available, such as QMB and many more. Thanks again!
What happens if you medicaid as secondary and you have been paying a copay to find out that the billing should have been billing medicaid for copay he was on a dsnp insurance
A DSNP is a type of Medicare Advantage Plan that combines the benefits of Medicare AND Medicaid. Are you saying that you have Medicaid in addition to a DSNP?
Environment is a sky and I'm a meditate have to get eligible for Medicaid and Medicare what disabilities or what can I do to get on both of them
I'm sorry. I'm not certain I understand your question. Could you please rephrase?
I have Medicare advantage plan. How do I get the otc food allowance benefit. I have chronic illness. I don’t have Medicaid . Am I egible to the food credit
Different advantage plans offer different benefits. There are many available and there are different plans available in different areas. If you have specific benefits in mind, please feel free to give us a call at 888-410-0344 and we can point you in the right direction.
I just received my approval letter for ssdi from the judge. In florida am I automatically eligible for medicare and medicaid or do I have to apply? My disability onset date is from 10 years ago.
I believe you need to apply for both, could be wrong. You can call them and ask.
Definitely call and ask. Remember, enrolling in Medicare and Medicaid is not the same as enrolling in a DSNP. DSNPs will offer all the same benefits (and more) BUT you have to choose to enroll in a specific plan. You can enroll on Medicare.gov or by contacting a broker. Feel free to give us a call at 888-410-0344. There is no charge for our services and we can walk you through all of the plans available to you.
Where do I find an honest broker. I have DSNP. I’m in NYC. What is the best insurance route to take
Hi Cyndi, are you happy with your current DSNP plan? Plans for 2023 haven't been released just yet, but even if you are happy with your current coverage, we advise that you review it as well as all of plans available for 2023. Plans tend to change yearly and more and more DSNPs are being offered.The AEP is Oct. 15-Dec. 7. As to your question, we are licensed nationwide if you'd like assistance. You can reach us at iHealthBrokers at 888-410-0344. Check out our reviews on google, yelp, trust pilot and Angie's list. There is no charge for our services. Best of luck and we hope to hear from you!
Why am I constantly being billed? I have dsnp. Yet, am receiving constant bills?? Constantly asked for co payments. Which is killing me financially. I don't get it??
Unexpected medical bills (especially those we don't understand) are terrible! We can't really help without more specifics though. If you have a broker you work with, they may be able to help. You can also contact your insurance carrier and have them explain and double check each code. You'd be surprised at how often the bills we receive are wrong!
Hi on social security n eliglbe for Medicare I am also on Medicaid do I have to pay the 170.00 premium
There is a premium for Medicare Part B that you have to pay. However, if you are eligible for Medicaid, you could look into a DSNP which may offer you some cost savings. There are also Medicare savings plans if you qualify based on your income and assets. If you have any other questions, please do not hesitate to ask!
Can a member have Medicare DSNP with one insurance and Medicaid DSNP with another ?
What is the difference between DSNP and MMP ?
A DSNP is type of Medicare Advantage Plan. It is one plan that combines the benefits of Medicaid & Medicare. The main difference between a DSNP and a MMP is the way the contract functions. Either may work for you.
Mmp
Estoy aplicando para mi Madicare , actualmente tengo Madicaid, me habían dicho que automáticamente califico para Extra Help
Mande la aplicación, pero me lo negaron dicen que porque no tengo récord de ayuda me pueden orientar con esto por favor.
llámanos: 888-410-0344
Great video, she has Medicare and recently was approved for QMB, would she qualify for a DSNP? If so, how would she go about it? Also, if she applies for A DSNP, would her eligibility be at risk for QMB? Thank you so much, I am happy there are people like you willing to help.
That's a great question. So, the QMB program helps to pay For Original Medicare. A DSNP is a type of Medicare Advantage program so it would replace Original Medicare (and therefore a QMB program) entirely. DSNPs are for those who are eligible for Medicare and Medicaid. Has she applied to Medicaid? If she's eligible for the QMB she may be eligible for Medicaid, but since different states have different criteria, you will definitely need to contact Medicaid to confirm. Also, you need to have proof of Medicaid eligibility to apply for a DSNP. If she were to choose a DSNP, she would no longer have Original Medicare (and her QMB program). If she decided to switch back to Original Medicare for any reason, she would likely have to reapply to the QMB program. I hope that helps!
@@iHealthBrokers FYI, there are Medicare Advantage (MA) plan options for partial-benefit dual-eligible individuals (PBDE) in some states, in addition to the full-benefit dual-eligible (FDBE), QMB+, and SLMB+ options. These plans for PBDE individuals are known as "partial D-SNPs" and are offered to Medicare Savings Program (MSP) groups. Plans for FBDE, QMB+, and SLMB+ are often considered full "D-SNP".
For these plans, you sign up for a MA plan and the insurance company checks your eligibility in the Medicare and Medicaid systems. Medicaid (via the MSPs) will pay for Part B premiums only if the person is eligible for a QMB or SLMB. I find that these partial D-SNPs often don't include QI or QDWI, though ( but if they do, they are very rare). The MSP will also pay for the Part B and copays/coinsurances and deductibles, but only if individuals are QMB eligible.
Virginia has partial D-SNP options and has a particular Medicaid contract related to these plans, just like it does for full D-SNP options.
If you have any questions, let me know.
Very helpful explanation
Thank you!
So, can you have medicaid and original medicare instead of medicare advantage?
You absolutely can! And if you are eligible for Medicaid and want to keep Original Medicare, you way want to look into a Medicare Savings Program to help pay for your premiums. Learn more here: th-cam.com/video/MQL7p-g3u7I/w-d-xo.html
I prefer doctors that are naturopaths. I have DSNP. How do I find a naturopath? I prefer an energy worker.
DSNPs are a type of Medicare Advantage. You can check with your carrier to find doctors who accept your plan. Best of luck!
Would a person be -required- to enroll in a DSNP if I am enrolled in both Medicare & Medicaid?
Absolutely not. It is still your choice. You may, however, want to look into a Medicare Savings Program if you qualify for some extra savings! th-cam.com/video/MQL7p-g3u7I/w-d-xo.html
All Advantage plans are a nightmare that dont approve anything or take so long the person suffers unnecessarily. DSNP are an even bigger nightmare. Most of the doctors in the plan do not accept medicaid (MediCal in california) as a secondary insurance leaving you with unpaid bills that you have to try to get paid by the secondary. Its a joke. I was told the DSNP would handle all that and that I would not receive any bills. Not true. I keep getting bills and they expect me to either pay it and get reimbursed by medicaid or I have to submit the bill to medicaid and hope it gets paid before my credit is ruined
So sorry to hear that you've experience such a head ache with your plan. Your healthcare provider is supposed to bill Medicaid and really you are not supposed to have to be the middle man. Medicare Advantage Plans (as with any private carrier insurance plans) can be excellent with good customer service or they can be a nightmare. Unfortunately for those with limited income, options may be limited. Definitely look into switching plans- we recommend working with a broker. You can also try for a Medicare Savings Program if you qualify based on income and assets. Best of luck and feel free to call if you need assistance. 888-410-0344
Question: Does Medicaid pay doctor copays & Inpatient hospital coverage?
So, these types of plans are a special type of Medicare Advantage Plan only available to those who are eligible for Medicaid and Medicare. The terms of your plans (copays, inpatient hospital coverage) would vary depending upon the plan that you choose.
@@iHealthBrokers Thank you so much!
@@CortneyWarren2050 Glad to be of help!
I am currently pregnant .. and my husband is self employed .. I don’t work . Can I apply for Medicaid
You can certainly try to apply for Medicaid. The criteria can be be rather stringent. They'll look at your income AND your assets. If you are denied, you'll want to look into a marketplace plan during your new special enrollment period. Start looking at marketplace plans now because there are only a few days left of open enrollment (Jan. 15). Many people are able to get plans for less than $10/month. Please don't wait to enroll in quality health insurance if you are pregnant. Feel free to call us at 888-410-0344 with questions and we will try to help. Also, make sure to check out our video about pregnancy and health insurance to learn more: th-cam.com/video/gYrgSctz4u8/w-d-xo.html Best of luck and congratulations!
Estoy tramitando mi Medicaré.
Actualmente tengo Medicaid, me dijeron que automáticamente yo califico para extra Help metí la aplicación, pero me lo negaron y dicen que porque no tengo récord de ninguna ayuda
Siendo que yo solo gano $12,000.00 al año .
Me podrían ayudar para aplicar de nuevo?
Hola Ana, llama a Medicaid para que te ayuden con tu record. En que estado vives?
Hi there, thank you so much for the info. My mom is turning 65 in February and I'm trying to help her with the Medicare situation. Do you still have to drop part B if you apply for DSNP? Also do you have to enroll during the enrollment period even if she doesn't turn 65 until February I'm asking because she's currently out of the country.
Good questions. Ok, so if she decides to enroll is a DSNP, she would no longer have Part B. However a DSNP would offer all of the same benefits as Part B with additional benefits as well. If she doesn't turn 65 until February, she can preview plans now, but she has until 3 months after her 65th birthday to enroll. No need to rush if you would like to help her and you are still out of the country! Safe travels!
I am 63 n will be 64 in February I receive ssi n ssdi I get Medicaid n only started ssdi when I turned 63 do I have to wait till I am 65 to get Medicare or can I receive it sooner
If I am reading this correctly, I think your biggest concern is having to pay back!
You may qualify early through disability. You should contact social security to be sure.
What about spend down to get Medicaid with medicare
Great question. Yes, even if your income alone would not qualify you for Medicaid, if your medical expenses are significant you may be able to subtract them from your income. This is known as spending down your income which could make you eligible for Medicaid. You can learn more here: www.cms.gov/Outreach-and-Education/Outreach/Partnerships/downloads/11249-P.pdf
Can i get it if am just married to an American citizen
Hi Christina. DSNPs require dual eligibility. So, you must be eligible for Medicare AND Medicaid. In order to be eligible for Medicare, you must meet certain criteria. You must be 65 or older and a US citizen OR a legal alien who has lived in the US at least 5 years. I hope that helps!
You said that you can help us about medicaid but when I called we can't help ! I call medicaid they don't unswer ! So who can help me is any body here know ?????
I'm sorry that you haven't been able to get in touch with Medicaid and I wish we had an answer to that. Medicaid is a government and state service so it's not something that health insurance brokers are able to assist with. We are however, able to help you with DSNPs which are a type of Medicare Advantage Plan for those who are eligible for Medicaid and Medicare. Should you need help with a DSNP, please feel free to give us a call. Best of luck!
here i am worked in india for usa medical billing if you have any remote part time work related to provider you can connect with me
We do not. Sorry!
She is just too happy.. UGH!!!!!!!!!!!!
So sorry you feel that way... Have a good one anyway!
No, it didn't explain anything in a way I could understand.
Sorry you feel that way.
I need help with understanding Medicare & Medicaid. I am disable. Can someone contact me?
If you are interested in a DSNP (plan for Medicare and Medicaid) please feel free to call us at 888-410-0344 and we can walk you through your options. We hope to hear from you!
We are senior citizens, green card holders& do not have any work credit. Whether we are eligible for dual plan of medicaid& Medicare, if our joint income is annually $0 in US & $24000/ globally.Please can you inform me the income limits for senior people with no work credit here ?