Why Medicaid eligibility is needed for D-SNP coverage

People who qualify for both Medicaid and Medicare are known as dual eligible. That’s because they’re dually eligible for both programs. Being dual eligible may also mean someone could qualify for a Dual Special Needs plan (D-SNP). D-SNPs are a type of Medicare Advantage plan that provide extra benefits beyond Original Medicare and Medicaid. But what happens if someone loses their Medicaid eligibility? Read on to find out.

In addition to qualifying for Medicare, having Medicaid coverage is also a requirement to enroll in a D-SNP. And that’s not just when you first join. To stay eligible, you need to keep your Medicaid coverage the whole time. If you lose your Medicaid eligibility, soon after you should get a letter from your health insurance company. This letter is to let you know that you no longer meet the D-SNP eligibility requirements.

When a D-SNP member no longer qualifies for Medicaid, they go into a grace period. Depending on the health plan, this grace period could be 30 days or up to 6 months. Members can still get care and services through their health plan. And Medicare will still pay for most of the care and benefits covered. The only difference is that, during the grace period, the D-SNP member will be responsible for any out-of-pocket costs. These could be copayments, coinsurance, deductibles and premiums that Medicaid would have paid for before.

If the grace period ends and you aren’t able to get recertified for Medicaid coverage, you will be disenrolled from your D-SNP or other Medicare Special Needs health plan. If so, your health plan will send you another letter telling you when your coverage will end. Then you’ll have a Special Enrollment Period (SEP) to enroll in a new Medicare Advantage plan or Original Medicare and a Medicare Part D (prescription drug plan). Your new coverage will start the month after your previous plan ends.

Partial dual eligibility is when someone qualifies for Medicare, but they don’t receive full Medicaid medical benefits. If you lose your full Medicaid medical benefits, but still participate in a Medicare Savings Program(MSP), you may qualify for a partial dual plan.* While Medicare pays for most of the care and benefits covered, many partial dual eligibles will be responsible for out-of-pocket costs. Learn more about partial dual eligibility.

*Coverage for people who qualify for partial dual eligibility is only available in certain areas.