Dual Eligible Special Needs Plans (2024)

Looking for the federal government’s Medicaid website? Look here atMedicaid.gov.

UnitedHealthcare Dual Complete plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare.Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Premium disclaimer

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

Benefit disclaimer

Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

Nurse Hotlinedisclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your provider's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time.Nurse Hotline not for use in emergencies, for informational purposes only.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® (Medicare-Medicaid plan)

UnitedHealthcare Connected® (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan) is a health plan that contracts withboth Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® general benefit disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the member handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® member handbook.

UnitedHealthcare Senior Care Options (HMO SNP) plan

UnitedHealthcare Senior Care Options (SCO) is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health Insurance, except Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our Senior Care Options (SCO) program.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system.The 5-Star rating applies to plan year 2024.

Important provider information

The choice is yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsem*nt of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate information

To report incorrect information, emailprovider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call1-888-638-6613/ TTY 711, or use your preferred relay service.

Declaration of disaster or emergency

If you’re affected by a disaster or emergency declaration by the President or a governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.

Dual Eligible Special Needs Plans (2024)

FAQs

What are some distinct advantages of a dual special needs plan? ›

D-SNP advantages and benefits
  • Low-cost coverage. Dual eligible enrollees have options to get help paying for premiums, deductibles, copays and coinsurance. ...
  • Convenience and care coordination. ...
  • Additional benefits and support.

What is the meaning of dual eligibility? ›

Background Discussion. Dual-eligible beneficiaries are individuals who receive both Medicare and Medicaid benefits. The two programs cover many of the same services, but Medicare pays first for the Medicare-covered services that are also covered by Medicaid.

What is exclusively aligned enrollment dual eligible special needs plans? ›

What is Exclusively Aligned Enrollment? occurs when the state contract limits enrollment in the D-SNP to full-benefit dually eligible individuals who receive their Medicaid benefits from the D-SNP or an affiliated Medicaid Managed Care plan offered by the same parent company as the D-SNP.

What is a dual eligible special needs plan quizlet? ›

What are Dual Special Needs Plans (D-SNP)? Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid.

What is the greatest challenge related to dual eligibles? ›

Separate eligibility requirements, benefits, and rules for Medicare and Medicaid sometimes contribute to what has been described as a “fragmented and disjointed system of care for dual eligibles” which may lead to difficulty in navigating care among dual-eligible individuals.

Which consumer might benefit the most by enrolling in a dual special needs plan? ›

Explanation: A consumer who might benefit the most by enrolling in a D-SNP UHC is someone who qualifies for both Medicare and Medicaid. D-SNP stands for Dual Eligible Special Needs Plans, which are specifically designed for individuals who are eligible for both federal health care programs.

What does dual eligible mean for FSA? ›

“Full duals" are individuals who are enrolled in Medicare Parts A, B, and D, and Medi-Cal. Over 90 percent of the 1.7 million dual eligible beneficiaries in California are full duals.

How many people in the US are dual eligible? ›

o The number of dually eligible beneficiaries increased from 8.6 million in 2006 to 12.3 million in 2019, an AAGR of 2.8 percent.

What is the difference between MMP and DSNP? ›

These plans streamline access to care through Medicare and Medicaid. But there's a key difference. With an MMP, all Medicare and Medicaid benefits are provided through 1 single health plan. With a D-SNP, members keep the same Medicaid plan and all the same Medicaid benefits as they get today.

What is a dual special needs plan D-SNP? ›

Dual Special Needs Plans (D-SNPs) are Medicare Advantage (MA) plans that provide specialized care to beneficiaries dually eligible for Medicare and Medi-Cal, and offer care coordination and wrap-around services.

Which of the following are the types of special needs plans? ›

There are three different types of SNPs:
  • Chronic Condition SNP (C-SNP)
  • Dual Eligible SNP (D-SNP)
  • Institutional SNP (I-SNP)
Sep 6, 2023

What entities provide coverage to individuals classified as dual eligibles '? ›

People who are dually enrolled in both Medicare and Medicaid, also known as dually eligible individuals, fall into several eligibility categories. These individuals may either be enrolled first in Medicare and then qualify for Medicaid, or vice versa.

What best describes a feature of a DSNP? ›

D-SNPs are for people who have both Medicare and Medicaid. A dual plan works together with your Medicaid plan. You keep all your Medicaid benefits. Plus, you could get many extra benefits and features for as little as $0 per month.

What is dual needs? ›

Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage (MA) health plans which provide specialized care and wrap-around services for dual eligible beneficiaries (eligible for both Medicare and ​Medicaid).

Which statement is true of DSNP members? ›

Which statement is true of D-SNP members? Members who are QMB+ or are Full Dual Eligible are not required to pay copayments for Medicare-covered services obtained from a D-SNP in-network provider. Their provider should bill the state Medicaid program, as appropriate, for these costs.

What are the benefits of UnitedHealthcare Dual Complete? ›

UHC Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. These SNP plans provide benefits beyond Original Medicare, such as transportation to medical appointments and routine vision exams.

What best describes a DSNP? ›

What is a D-SNP? Dual Eligible Special Needs Plans, commonly known as D-SNPs, represent a unique category within Medicare Advantage plans, tailored specifically for individuals who simultaneously qualify for both Medicare and Medicaid.

What are some of the benefits and disadvantages of the various types of Medicare Advantage plans? ›

The takeaway
  • Medicare Advantage offers many benefits to original Medicare, including convenient coverage, multiple plan options, and long-term savings.
  • There are some disadvantages as well, including provider limitations, additional costs, and lack of coverage while traveling.

Can you have an advantage plan and a supplemental plan? ›

A Medicare Advantage Plan is another way to get your Medicare coverage besides Original Medicare. A Medigap policy is a supplement to Original Medicare coverage. When you're getting started with Medicare, you can either buy Medigap or enroll in a Medicare Advantage Plan, but you can't have both.

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