Dually Eligible Recipients
Dual-Eligible recipients are individuals who receive both Medicare and Medicaid benefits. The two programs cover many of the same services. Dual-eligible beneficiaries (or "duals") are enrolled in both Medicare and Medicaid. There are different types of dually eligible recipients. A Full Benefit Dual Eligible (FBDE) has access to all Medicaid services and Medicaid also pays for the Medicare premiums, co-insurance and deductible. For a Qualified Medicare Beneficiary (QMB), Medicaid only pays an individual's Medicare premiums, co-insurance and deductible amounts up to Medicaid allowable amounts.
Recipients who enroll in a D-SNP who are Full Dual Eligibles DO NOT lose any existing Medicaid benefits for their current benefit plan such as Personal Care Services and Non-Emergency Transportation. If you have questions regarding your current benefit plan, please contact the Medicaid District office at (800) 992-0900. For more information on services, please refer to the Welcome to Nevada Medicaid booklet.
Overview of Dual Eligible Special Needs Plans
A Dual Eligible Special Needs Plan (D-SNP) is an optional program within Medicare Advantage plans for individuals who are eligible for both Medicare and Medicaid coverage. This plan is designed to coordinate care among Medicare and Medicaid to improve care more effectively while also lowering costs. In addition to care coordination, D-SNPs can also offer supplemental benefits not typically available under Medicare but offered through Medicaid programs.
Eligibility for D-SNP
A person must be eligible and enrolled in Medicare Part A and/or Part B and receiving Medicaid benefits or Medicaid assistance with Medicare premiums or cost sharing. Nevada has chosen these two dual eligible categories to participate in DSNP:
- Full Benefit Dual Eligible (FBDE)
- Qualified Medicare Beneficiary (QMB)
Benefits of D-SNP
As of October 2020, Nevada had over 77,800 Dual Eligible recipients. With such a large population of dually eligible recipients with high utilizations of Medicaid services, there are opportunities to better coordinate care through a D-SNP program with the goal of improving quality of care and the addition of more services.
There is no change in Medicaid eligibility or benefits to a Medicaid recipient who enrolls with a D-SNP program. Most dual health insurance plans also give more benefits than offered with traditional Medicare at no extra cost.
Nevada Medicaid has chosen to make available the following seven services for eligible D-SNP recipients.
- Hearing Aids
- Non-emergency transportation to and from medical visits, including pharmacy
- Personal Emergency Response Systems (PERS)
- Nursing Hotline
- Meal Services post-acute
Beginning January 1, 2021, there are four Medicare Advantage Plans participating in the D-SNP program. Each Medicare Advantage Plan must provide the seven services listed above; however, there may be additional services offered to a D-SNP member as detailed on the right by each plan.
DHCFP is open to partner with all Medicare Advantage Plans who are eligible to provide D-SNP plans within Nevada. Please contact The Centers for Medicare and Medicaid Services (CMS) for additional information on plan filing dates. You may contact DHCFP to notify the Division of your intentions to offer a D-SNP plan within the state.
Below you will find plans and information regarding accessing them.
Use links to the website or the direct summary of benefits below to access benefit information. Enter your zip code and scroll to the Aetna Medicare Prime Plan (HMO D-SNP) H4711-011 and select Plan details.
Phone Numbers: (TTY: 711) Phones operate 7 days per week, 8am to 8pm
To enroll: Call us at 1-844-950-3513 (TTY: 711)
Already a Member: Call us toll free at 1-866-409-1221 (TTY: 711)
Use the link below to access plan information. Once on the Anthem site, please enter your zip code and select View All Plans. From the Medicare Advantage Plan options, review the Anthem Medicare Dual Advantage (HMO D-SNP) or Anthem Medicare Connect (HMO D-SNP) for those who are eligible for Medicare and Medicaid.
Phone Number: 1-844-309-6995
Allwell from SilverSummit Healthplan
Information about Dual Special Needs Plan (D-SNP) benefits, services and drug coverage can be found in the Summary of Benefits link below.
Phone Number: 1-800-606-3604
2021 UnitedHealthCare Dual Complete® (HMO D-SNP) is for people who qualify for both Medicaid and Medicare Part A or B (Original Medicare).
Have questions: Call from 8am to 8pm, local time, Monday - Friday
Phone Number: 1-844-812-5967 (TTY: 711)