Did You Know: Dual Special Needs Plans

Dual Special Needs Plans (D-SNPs) are network-based. These plans require members to get care and services from doctors or hospitals in their Medicare SNP network.

If someone is full dual, meaning they are eligible for full Medicaid and Medicare, they are eligible for a Dual Special Needs Plan. Most DSNPs are HMOs, in other words it’s very important to check the doctors and hospitals that the beneficiary would be using. When selecting a DSNP, they specifically ask for your Primary Care Physician on the application to make sure they are in-network. Medicaid will NOT automatically step in and pick up if you go outside your plans network. However, if the same carrier manages the Medicare Advantage Plan and the CHC Medicaid portion there may be a chance for coordination of benefits.

Coordination of benefits (COB) applies to people who have coverage under more than one health plan. COB refers to which plan is the primary (first) payer and which plan is the secondary payer. The primary payer coordinates the delivery of all health plan benefits. The secondary payer covers what the primary payer doesn't cover on costs and benefits.

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Learn more: https://www.uhc.com/communityplan/dual-special-needs-plans/faq