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Medicare : Special Needs Plans

 

Special Needs Plans for Dual Eligible individuals (D-SNPS) are specially designed Medicare Advantage plans that include Prescription Drug Coverage and other benefits for people who have both Medicare Parts A and B, and Medicaid. 

 

Programs that help people with Medicare cover some or all of their Medicare costs are called “Medicare Savings Programs” and include the following:

 

  • Qualified Medicare Beneficiary (QMB): Helps pay Medicare Part A and Part B premiums, and other cost sharing (like deductibles, coinsurance, and copayments). (Some people with QMB are also eligible for full Medicaid benefits (QMB Plus).)
  • Specified Low-Income Medicare Beneficiary (SLMB): Helps pay Part B premiums. (Some people with SLMB are also eligible for full Medicaid benefits (SLMB Plus).)
  • Qualifying Individual (QI): Helps pay Part B premiums.
  • Qualified Disabled & Working Individuals (QDWI): Helps pay Part A premiums.
  • Full Benefit Dual Eligible (FBDE): Helps pay Medicare Parts A and B premiums, and other cost sharing (like deductibles, coinsurance, and co-payments.  FBDE members receive full Medicaid benefits.

 

Depending on your level of Medicaid, WellCare may have a D-SNP that meets your needs.

 

Access Plan:
To be eligible for this plan, potential enrollees must qualify as Dual Eligible in the state hold harmless categories for Part A and B cost sharing. Hold harmless provisions vary by state, so please contact us for more information about the Access plan in your area. Access plans are offered in defined service areas in CT, FL, GA, IL, KY, LA, MO, NY, OH and TX.

 

New York Liberty Plan:
To be eligible for this plan, potential enrollees must have both Medicare Parts A and B, receive   full Medicaid benefits as a QMB Plus or Full-Benefit Dual Eligible and be enrolled in the state’s Medicaid Advantage program.

 

Florida Liberty Plan:
To be eligible for this plan, potential enrollees must have both  Medicare Parts A and B, and have partial or full  Medicaid benefits as a QMB or QMB Plus.

 

Florida Select Plan:
To be eligible for this plan, potential enrollees must have both Medicare Parts A and B,  and receive partial Medicaid benefits as a SLMB, QI or QDWI.

 

'Ohana Liberty (HI): 
To be eligible for this plan, potential enrollees must have both Medicare Parts A and B, have full Medicaid benefits as a QMB Plus, Full Benefit Dual, or SLMB Plus  and be  enrolled in the state's Medicaid managed care program for aged, blind and disabled (QEXA).

 

To see if you are eligible for one of our Special Needs Plans, or you want to enroll or receive plan information, contact us.

You must continue to pay your Medicare Part B premium unless your premium is paid by Medicaid. If you meet certain eligibility requirements for both Medicare and Medicaid, your Part B premiums may be covered in full. Some plans are available to those who have medical assistance from both the state and Medicare. Premiums, co-pays, coinsurance and deductibles may vary based on your level of Medicaid eligibility and the Extra Help from Medicare to pay your prescription drug costs that you receive. Please contact the plan for further details.

 


Y0070_NA023899_WCM_WEB_ENG CMS Approved


Last modified: 01/01/2014

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