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Medicare : Special Needs Plans

 

Special Needs Plans are for people who are eligible for both Medicare and Medicaid. They are Medicare Advantage plans that include Prescription Drug Coverage and other benefits. 

 

People who are eligible for a Special Needs Plan usually also qualify for a program that helps people with Medicare cover some or all of their Medicare costs. These 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 co-payments). 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 Special Needs Plan that meets your needs.

 

Access Plan:
This plan may be an option for you if you are eligible for both Medicare and Medicaid, and your Medicare Part A and Part B co-sharing is covered by your state's Medicaid program. Eligibility rules may 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 Connecticut, Florida, Georgia, Illinois, Kentucky, Louisiana, New York, Texas, Mississippi, Arkansas, Tennessee and South Carolina.

 

New York Liberty Plan:
This plan may be an option for you if you have both Medicare Parts A and B, receive full Medicaid benefits as a QMB Plus or FBDE and are enrolled in the state’s Medicaid Advantage program.

 

Florida Liberty Plan:
This plan may be an option for you if you have both Medicare Parts A and B, and have partial or full Medicaid benefits as a SLMB Plus, QMB Plus or FBDE.

 

Florida Select Plan:
This plan may be an option for you if you have both Medicare Parts A and B, and receive partial Medicaid benefits as a SLMB, QI or QDWI.

 

To see if you are eligible for one of our Special Needs Plans, or 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-payments, coinsurance and deductibles may vary based on your level of Medicaid eligibility and the Extra Help you receive from Medicare to pay your prescription drug costs. Please contact the plan for further details.

 


Y0070_NA027269_WCM_WEB_ENG CMS Approved


Last modified: 10/02/2014

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