MOUNT VERNON — An insurance plan designed for low-income individuals is now available in Knox County. Dual Eligible Special Needs Plans (D-SNPs) are available to those who qualify for full Medicare and Medicaid benefits.
“I think it’s a wonderful thing in that it pays for healthcare for some of the most vulnerable in our population,” said Matthew Kurtz, director of Knox County Jobs and Family Services.
“Beneficiaries who are dually eligible for both Medicare and Medicaid can face significant challenges in navigating the two programs, which include separate or overlapping benefits and administrative processes,” said Jibril Boykin, press officer for the Centers for Medicare and Medicaid Services. “Under plans that offer integrated care, dually eligible beneficiaries receive the full array of Medicaid and Medicare benefits through a single delivery system.”
Since D-SNPs distribute benefits through a private plan, clients have more freedom in how they choose to use those benefits. In some cases, beneficiaries can access a wider variety of services than what’s traditionally covered by Medicare and Medicaid.
Leslie Franz, an agent with ProCore Health Brokers, said that D-SNPs are designed to offer clients preventative healthcare and can be used to cover dental, hearing and vision care. They can also be used to cover fitness memberships, transportation to health-related appointments and over-the-counter purchases like cold medicine, vitamins and adult diapers.
Kurtz said this approach is ultimately better for clients’ health and may use funding for health benefits more efficiently. According to Kurtz, many of the costly hospital stays paid for by Medicare and Medicaid could have been prevented if the person had had basic, routine treatment early on.
“It’s less expensive to intervene sooner than wait until it’s a catastrophe,” he said.
Routine medical care such as regular physicals and blood tests can help enrollees take better care of themselves, detect health problems sooner and treat those problems before they spiral out of control.
Unfortunately, manageable conditions are often ignored by people who can’t afford the services Medicare and Medicaid don’t cover.
“It’s like putting a piece of electrical tape over your check engine light and waiting for the engine to explode,” said Kurtz.
Instead of waiting until dire needs arise, managed care plans are designed to keep patients healthy, said Franz. “It can be life-changing. The other day we met with someone who was on Medicare and Medicaid and she has abscess teeth that need to be pulled...It compromised her health and she couldn’t eat well,” said Franz. The client’s previous plan wouldn’t cover the procedure, but her D-SNP does. “She was crying because now she can get the help that she needs.”
Franz said D-SNPs do not jeopardize the coverage a person may already be receiving through Medicare and Medicaid.
Those who qualify for full Medicaid and Medicare coverage typically have no monthly premium and little to no out-of-pocket costs with most D-SNP plans, said Rose Florez, a health insurance agent with Cornerstone Client Services.
Florez added that not all levels of Medicaid and Medicare coverage make a person eligible for a D-SNP. Nevertheless, she encouraged anyone who thinks they might be eligible to apply.
Once approved by Medicare and Medicaid, applications can be submitted by a health insurance agent, UnitedHealthcare or the Knox County Department of Job and Family Services. The Department of Job and Family Services can help people determine whether or not they are eligible.
“There’s no reason not to apply for it,” said Kurtz. “The worst thing that could happen is you’re told you aren’t eligible.”
For more information, contact Knox County Job and Family Services, a health insurance agent or call 1-800-MEDICARE (1-800-633-4227).
