Dual Special Needs Plans

Roughly 13 million Americans are eligible for both Medicare and Medicaid, often referred to as dual-eligibles. If you are dual-eligible, you have several options for how your coverage and care are coordinated. You can use Original Medicare along with your Medicaid benefits separately. You would need to enroll in a prescription drug plan. If available in your area, you can enroll in a DSNP (Dual Special Needs Plan) which is designed to specifically coordinate both Medicare and Medicaid in one plan and usually included additional benefits. The plan that offers broader Medicare coverage to a specific, limited population. SNPs are tailored to meet the needs of their members, which are typically people with:

• Low income
• Certain medical conditions
• Unique health care requirements 

To decide what path is best for your needs it is important check that your doctors are in the network and your prescriptions are covered by the formulary. This is how we help.

Chronic Special Needs Plans

A Chronic Condition Special Needs Plan (C-SNP) is a type of SNP. While D-SNPs are for people with both Medicare and Medicaid eligibility, C-SNPs are designed for people who have a specific chronic or disabling condition (e.g., diabetes or heart disease). C-SNP members may have access to a network of providers who specialize in their condition and better coverage for prescription drugs used to treat their condition.

Extra Help

Extra Help, also known as Low Income Subsidy (LIS), is a federal program that helps people with limited income and resources pay for their Medicare Part D prescription costs. It is administered by the Social Security Administration and Medicare. If you qualify, if can significantly reduce your monthly Part D premium, annual deductible, and copays & coinsurance for prescription drugs. It also eliminates the Part D late enrollment penalty. To qualify your income and assets must be under certain limits. To see if you qualify, please contact us for assistance.

Medicare Savings Program

The Medicare Savings Program (MSP) is a state-run program that helps people with limited income and resources pay for some or all of their Part A and Part B costs—such as premiums, deductibles, coinsurance and copayments. There are four types of Medicare Savings Programs, each with slightly different income and asset limits. If you qualify for any MSP, you automatically qualify for Extra Help (LIS) to lower your Part D drug costs. To see if you qualify, please contact us for a consultation.

Justice in Aging

Justice in Aging is a national nonprofit legal advocacy organization dedicated to ensuring that low-income older adults have access to the services they need to live with dignity. Their work focuses on improving access to healthcare, economic security and the rights of older adults, particularly those who are dually eligible for Medicare and Medicaid. They advocate for better coordination, ensuring equity, and consumer protections.