Today, there are approximately 12 million individuals eligible for both Medicare and Medicaid — also known as dually eligible individuals — in the United States. Dual Special Needs Plans (DSNPs) offer coordinated care for dually eligible individuals to make it easier to understand eligible services and improve care access. Through this enhanced coordination, DSNPs improve member experiences, lower the risk of duplicative services, improve health outcomes and reduce administrative burdens.
In this video, UnitedHealthcare Community & State leaders cover the difference between Medicare and Medicaid programs, who is considered dually eligible and how DSNPs benefit both members and states.
Dual Special Needs Plans provide nuanced care for a complex population. How well do you know DSNP? Test yourself! Take the DSNP knowledge quiz.
What are the major differences between Medicare and Medicaid?
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Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income. Medicaid is a federal-state partnership that is administered by states and is primarily for people with low incomes.
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Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income. Medicaid is a federal-state partnership that is administered by states and is primarily for people with low incomes.
What does dually eligible mean?
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Individuals may qualify for BOTH Medicare and Medicaid, because of their age and/or their disability status and income. When someone qualifies for both programs, they are referred to as dually eligible.
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Individuals may qualify for BOTH Medicare and Medicaid, because of their age and/or their disability status and income. When someone qualifies for both programs, they are referred to as dually eligible.
Someone has to be over 65 to qualify for Medicare & be dually eligible?
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Medicare provides health care coverage for those 65 and over, as well as those under 65 with a disability, regardless of their income.
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Medicare provides health care coverage for those 65 and over, as well as those under 65 with a disability, regardless of their income.
Roughly how many individuals in the US are dually eligible for Medicare and Medicaid?
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There are roughly 12 million individuals dually eligible for Medicare and Medicaid in the United States. These individuals typically have complex medical and social needs and require a coordinated set of health care and social services.
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There are roughly 12 million individuals dually eligible for Medicare and Medicaid in the United States. These individuals typically have complex medical and social needs and require a coordinated set of health care and social services.
What percent of dually eligible individuals have at least one mental health diagnosis?
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41% of dually eligible individuals have at least one mental health diagnosis, 49% receive Long-Term Services and Supports, and 60% manage multiple chronic conditions.
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41% of dually eligible individuals have at least one mental health diagnosis, 49% receive Long-Term Services and Supports, and 60% manage multiple chronic conditions.
When someone is dually eligible for Medicare & Medicaid the _____ program always pays first?
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When it comes to paying for services, the Medicare program always pays first, and Medicaid picks up the cost share or covers certain services as primary payer that Medicare may not cover.
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When it comes to paying for services, the Medicare program always pays first, and Medicaid picks up the cost share or covers certain services as primary payer that Medicare may not cover.
Under each program, individuals typically have the opportunity to receive their services through fee-for-service or managed care arrangements.
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Under each program, individuals typically have the opportunity to receive their services through fee-for-service or managed care arrangements. In fee-for-service, individuals have a Medicare and/or Medicaid card and are able to go to any provider willing to accept Medicare and/or Medicaid. Customer support is limited, and there are no clinical programs or additional benefits.
Sorry, that wasn't right.
Under each program, individuals typically have the opportunity to receive their services through fee-for-service or managed care arrangements. In fee-for-service, individuals have a Medicare and/or Medicaid card and are able to go to any provider willing to accept Medicare and/or Medicaid. Customer support is limited, and there are no clinical programs or additional benefits.
There is a Medicare Advantage plan that serves individuals who are dually eligible for Medicare and Medicaid. It is called?
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There is a specific Medicare Advantage plan that serves individuals who are dually eligible for Medicare and Medicaid, known as Dual Eligible Special Needs Plans, or DSNPs. These plans are tailored to the unique needs of the dual eligible population. DSNPs, which are available only through managed care, offer enhanced benefits and a streamlined experience for dual eligibles as they navigate multiple, complex programs.
Sorry, that wasn't right.
There is a specific Medicare Advantage plan that serves individuals who are dually eligible for Medicare and Medicaid, known as Dual Eligible Special Needs Plans, or DSNPs. These plans are tailored to the unique needs of the dual eligible population. DSNPs, which are available only through managed care, offer enhanced benefits and a streamlined experience for dual eligibles as they navigate multiple, complex programs.
A dual special needs plan (DSNP) is specific to managed care & designed to better coordinate benefits for the beneficiary.
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By signing up for a Managed Medicare or Managed Medicaid plan, individuals are able to access the same base benefits but get additional support, benefits and clinical programs offered through their health plan.
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By signing up for a Managed Medicare or Managed Medicaid plan, individuals are able to access the same base benefits but get additional support, benefits and clinical programs offered through their health plan.
A big advantage of DSNPs is that they offer additional benefits compared with fee-for-service or traditional Medicare Advantage products.
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A DSNP offers individuals the same base benefits but get additional support, benefits and clinical programs offered through their health plan.
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A DSNP offers individuals the same base benefits but get additional support, benefits and clinical programs offered through their health plan.
