Who is eligible for a Dual Special Needs health plan?

Posted: January 17, 2020

“Dual-eligible” means you qualify for both Medicaid and Medicare health insurance programs. You may also hear this type of eligibility called “DSNP eligibility” or “Medicare SNP eligibility” since Dual Special Needs Plans are a type of Medicare Advantage Plan.

So, what exactly does it take to qualify for a dual-eligible health plan? If you can answer “yes” to all of the questions below, chances are you can get a dual-eligible health plan. These plans are also known as Dual Special Needs Plans. (Find out more about dual-eligible health plans.)

Do you have Medicaid or get financial help?

The Medicaid health care program for your state is managed by your state government. The rules to qualify for Medicaid depend on your state. Do you get financial help such as supplemental security income (SSI)? If you have low income, you may qualify for Medicaid.

To find out if can get Medicaid in your state, check with your state Medicaid agency. You’ll find a link to the website for your state Medicaid agency on the “Plan Details” page for each of our health plans. To see the plans we offer in your area, please search plans in your state.

Do you have Medicare Parts A and B?

Medicare is a national health insurance program run by the federal government. It’s for people age 65 and older, and also some people under age 65 with certain disabilities. To be eligible for Medicare, you also have to be a U.S. citizen or a legal resident who has lived in the U.S. for at least 5 years.

Medicare Part A is hospital insurance. Medicare Part A covers certain services that you may get as an inpatient during a stay in hospital or a skilled nursing facility. Medicare Part B is medical insurance. Medicare Part B covers certain doctor services and preventive care. Together, Medicare Parts A and B are also known as Original Medicare. 

Do you live in the plan's service area?

What dual-eligible plans you can get depends on where you live. Your home address needs to be in the dual plan’s coverage area to be eligible for that specific dual-eligible health plan. To find a UnitedHealthcare Dual Complete® plan for you, please search plans in your state. 

Do you meet the dual plan’s health requirements?

Some dual-eligible health plans have extra requirements based on certain health conditions. If you have a serious, long-term health condition, speak with a UnitedHealthcare licensed sales agent to discuss your specific situation.

In a nutshell: Can you qualify for a dual-eligible health plan?

Do you qualify for both Medicare and Medicaid? You may be eligible to qualify for a dual eligible plan if:

  • You qualify for Medicaid in your state
  • You qualify for Medicare Parts A and B (Original Medicare)
  • You live in the dual-eligible plan’s coverage area
  • You meet the dual-eligible plan’s health requirements (if any)
     

Sign Up for the D-SNP Webinar

Learn about being dual-eligible and dual health plans in this short webinar. You'll also get informative emails to help you navigate your Medicare choices.

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See UnitedHealthcare plans in your area.

Please note that the specific benefits dual health plans include can change depending on where you live. Search by your ZIP code to find the right plan to meet your health care needs. 

Please note: If you have end stage kidney failure (ESRD), there are specific requirements on whether you will qualify for a dual-eligible plan. If that’s the case, please talk with a UnitedHealthcare licensed sales agent to discuss your specific situation.

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