Medicare Advantage 

Medicare Advantage, also known as Medicare Part C, is an alternative way to receive your Medicare benefits. Here's a breakdown of what it entails:

1.          Integration with Original Medicare: When you enroll in a Medicare Advantage Plan, it takes the place of Original Medicare (Part A and Part B). This means you receive all of your Medicare benefits through the Medicare Advantage Plan rather than through Original Medicare.

2.          Additional Benefits: Medicare Advantage plans often include extra benefits not covered by Original Medicare, such as dental, vision, and hearing services. Many also include prescription drug coverage (Part D).

3.          Enrollment Requirements: To enroll in a Medicare Advantage Plan, you must first be enrolled in both Medicare Part A (hospital insurance) and Part B (medical insurance). You cannot have both a Medicare Advantage Plan and a separate Medicare Supplement (Medigap) policy.

4.          Network and Referral Requirements: Most Medicare Advantage plans operate with specific networks of doctors and hospitals. In many cases, you'll need to get a referral from your primary care doctor to see a specialist. Some plans also require prior authorization for certain tests and treatments.

Special Needs Plans (SNPs)

• What It Is: A type of Medicare Advantage Plan specifically designed for people with specific health conditions or who are in certain situations, such as those living in nursing homes or with chronic diseases.
• Types: Includes Chronic Condition SNPs, Dual Eligibility SNPs (for those eligible for both Medicare and Medicaid), and Institutional SNPs.

 What Are Dual Eligible Special Needs Plans (D-SNPs)?

• Target Audience: D-SNPs are tailored for individuals who are eligible for both Medicare (Parts A and B) and Medicaid. This eligibility often means that individuals have low income and limited resources.
• Coverage: D-SNPs combine Medicare and Medicaid benefits into one plan. They cover all the services provided under Medicare (hospital, medical, and in many cases, prescription drugs) and include Medicaid benefits, which may cover additional services like long-term care, transportation to medical appointments, and personal care services.

Benefits of D-SNPs

• Integrated Coverage: D-SNPs integrate Medicare and Medicaid benefits, which can simplify the process of managing your health care and reduce out-of-pocket costs. This integration can help coordinate care and provide a more comprehensive approach to health management.
• Additional Services: These plans often provide additional services beyond what is covered by Medicare alone, such as dental, vision, and hearing care, depending on the plan and your specific Medicaid benefits.

Low or No Cost: Many D-SNPs have low or no monthly premiums and can cover the cost-sharing requirements that would otherwise be your responsibility under Medicare.

 How D-SNPs Work

• Provider Networks: D-SNPs often use specific provider networks. You may need to use in-network doctors and hospitals to get the full benefits of your plan.
• Care Coordination: These plans may offer enhanced care coordination services, helping you manage your health care needs by coordinating between your Medicare and Medicaid services.
• Eligibility Requirements: To qualify for a D-SNP, you must be eligible for both Medicare and Medicaid. You also need to live in the service area of the D-SNP you wish to enroll in.

Enrollment in D-SNPs

• Enrollment Periods: You can enroll in a D-SNP during the Initial Enrollment Period (when you first become eligible for Medicare), the Annual Enrollment Period (October 15 to December 7), or during a Special Enrollment Period (such as if you move or lose other coverage).
• State-Specific Options: The availability of D-SNPs can vary by state and region. Each state has its own Medicaid program, and the benefits and options available through D-SNPs can differ accordingly.

Choosing a D-SNP

• Assess Your Needs: Consider your health care needs and the specific benefits provided by various D-SNPs. Look for plans that offer the additional services you may require and check the provider networks.
• Consult with Experts: It can be helpful to consult with a Medicare advisor or use online tools to compare different D-SNPs available in your area.

Overall, D-SNPs aim to provide a more seamless experience for those who are eligible for both Medicare and Medicaid, helping to integrate and simplify the management of their health care benefits.

Our Offerings: We currently represent 78 organizations which offer 2,613 products in AZ and NV. We do not offer every plan available in your area. Please contact www.medicare.gov, 1.800.medicare, or your local State Health Insurance Program (SHIP) to get information on all your options.