DSNPs - Medicare/Medicaid Dual Plans | Cypress Health and Life

Dual Plans: Understanding DSNP Coverage and Options

Starting in 2025, there have been several changes effecting those with both Medicare and Medicaid (DSNP or Dual Special Needs Plans).

Understanding Your Plan - Reviewing your policy documents AND/OR connecting with your insurance agent directly are the best ways to find out what your plan covers. And if there is an adjustment that makes better sense.

Many Available Dual Plans Still Offer:

"Flex Cards" with monthly allowances for Groceries, Utilities (Gas/Electric/Cell), OTC, etc
Higher Dental / Vision Allowances
LIS / Extra Help for Prescription Savings / Coverage
$0 Copays for Doctors, Hospital, ER, Urgent Care, etc

By prioritizing your health, being in the right plan and understanding your insurance coverage and options, you can ensure you have the resources you need to enjoy the benefits without surprises.

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Medicare / Medicaid DSNP Integration Partner in IN, OH & VA

And in Texas w/ - a division of Anthem

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To Review Your Best Options, can Call / Text at 346-567-8300, E-mail or Schedule an Appointment at the top right of this web site.

Recent 2025 Updates:

As of 2025, there is new rule regarding changing DSNP (Dual Eligible Special Needs Plan) plans that removes the old "Quarterly Switch Option" and individuals can SOMETIMES only switch to a DSNP that is considered "integrated" or "aligned" with their Medicaid plan (outside of AEP/OEP). Meaning they can't freely switch between any DSNP they choose ALL year long.

Key points about the new DSNP Enrollment Guidelines:

Limited switching options: At many times of the year, Individuals can only switch to a DSNP that is closely aligned with their Medicaid plan, restricting their ability to choose any DSNP they want.

Integrated Care SEP:

The ability to change plans is now primarily through a monthly "Integrated Care SEP" instead of the previous quarterly option.

Medicaid managed care link:

To switch DSNPs, individuals often need to be enrolled in a Medicaid managed care plan that is affiliated with the desired DSNP.

Impact on non-integrated plans:

Individuals in states without integrated DSNP options may have fewer opportunities to switch plans.

Did Your Copays Remain at $0.00 vs 20%???

Another BIG Change is some DSNP plans might have switched from a $0 copay to a 20% copay on many services. This might be because your Current DSNP Plan changed for 2025 or you lost your Medicaid level/eligibility (SLMB, QMB, Full, etc). The Medicaid status/level is a key requirement to maintain a DSNP plan with no copays. If you no longer qualify for Medicaid, your plan may adjust your cost-sharing to reflect the standard Medicare copay structure, which could be around 20% of the service cost.

Key points to remember:

Medicaid is crucial for DSNP eligibility: - Communication is Key!

To be enrolled in a DSNP, you need to qualify for both Medicare and Medicaid. If you haven't stayed in communication with Medicaid on a yearly basis (at least), it is a good idea to confirm your status.

Losing Medicaid (even temporarily) can impact cost-sharing:

If you lose your Medicaid eligibility or have a level change, your DSNP plan may adjust your copays to reflect the standard Medicare cost-sharing, which could mean paying a percentage like 20%.

Check your eligibility status:

Regularly review your Medicaid eligibility to ensure you can maintain your DSNP plan with the intended benefits. As your Agent, we can help with that!

What to do if this happens:

Contact Us... We are YOUR Medicare/DSNP Agent...

We can reach out to your DSNP provider to understand the exact reason for the copay change and to explore options if you believe there might be an error.

Contact Us... so we can Review/Check your Medicaid status:

We can check online with your state Medicaid office to see if you are still eligible for Medicaid coverage and that particular plan.

As your dedicated Agent, we can help consider alternative plan options; even if only temporary while we fix any Medicaid issues:

If you can no longer maintain your DSNP due to lost Medicaid eligibility, explore other Medicare Advantage plans that might better suit your needs.

To Review Your Best Options, can Call / Text at 346-567-8300, E-mail or Schedule an Appointment at the top right of this web site.

Notes: This is a solicitation for insurance. Submitting information or calling numbers listed on this website will direct you to a licensed Agent/Broker. Important disclosures about Medicare Plans: Medicare has neither endorsed nor reviewed this information. Not connected or affiliated with any United States Government or State agency. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Much of this information is not guaranteed and some was sourced on Google / Generative AI.

Dual Plans: Understanding DSNP Coverage and Options

To Review Your Best Options, can Call / Text at 346-567-8300, E-mail or Schedule an Appointment at the top right of this web site.

Recent 2025 Updates:

Key points about the new DSNP Enrollment Guidelines:

Did Your Copays Remain at $0.00 vs 20%???

Key points to remember:

What to do if this happens:

To Review Your Best Options, can Call / Text at 346-567-8300, E-mail or Schedule an Appointment at the top right of this web site.

Medicare Coverage Basics