New Jersey's Dual-Eligible Special Needs Plans - The Facts

You may find that when you're enrolled in Medicare that you need additional assistance with the cost of healthcare. You cannot afford premiums or expanded packages that would allow you access to the treatments needed. With a limited income/assets you may be eligible for Medicaid on top of Medicare, which makes you dual-eligible. If you are in this situation there are two routes you can take.

  1. Enroll in Medicare, a Medicaid HMO (administered through NJ FamilyCare), and a separate plan for prescriptions.
  2. Enroll in a Dual Eligible Special needs plan which combines your Medicare, Medicaid, and Prescription Drug coverage into one plan.

In New Jersey, there are a number of options available depending on the county you live in.  With Dual Special Needs Plans you have one card, one payer, one insurance, no juggling, no fuss. 

Who in New Jersey Is Eligible for D-SNP? 

If you're already dual-eligible as a New Jersey resident, it doesn't hurt to look into a D-SNP plan. Dual-eligibility is dependent on already being on Medicare and Medicaid. To be eligible for Medicare, you need to be: 

  • Aged 65 or older and a US citizen or legal permanent resident;
  • Under 65 but legally disabled for two years or diagnosed with either Lou Gehrig's disease or end-stage renal disease

Medicaid is healthcare that goes to people who cannot otherwise afford insurance. To be eligible for Medicaid in New Jersey, you need to be: 

  • A resident of New Jersey;
  • A US citizen or qualified legal resident;
  • Meet specific standards for income and financial resources; and
  • Qualify for the ABD Programs (Aged, Blind, or Disabled)

If you are enrolled in both Medicare and Medicaid, then a Dual plan could be the next step to simplifying your access to healthcare. 

What Services Can You Access with a Dual-Eligible Special Needs Plan?

If you are enrolled in a Dual Special Needs Plan, you should keep your Medicare and Medicaid cards, however you use your Dual Special Needs Card at the doctor, hospital, and pharmacy instead of the other cards. A Dual Special Needs Plan includes all the member benefits you would normally enjoy under Medicare and Medicaid separately. 

It also involves:

  • No copayments, premiums, or deductibles—a relief for any low-income patient who's ever panicked over a medical bill. 
  • Additional benefits that may not be available under just Medicare or Medicaid.
  • A single health plan to manage all your benefits, and that includes managed long term care and support. 

Most of your Dual Special Needs Plan care options will be paid for through the Medicare side of things, but some services are exclusively Medicaid services, such as dental, vision, hearing, and in-residence care, just to name a few. 

Consult Your Medicare Options with a Medicare Broker.

Do you have questions or concerns about your dual-eligible benefits and care? Do you want to look into a dual-eligible plan to handle your Medicare and Medicaid? Consider speaking with an expert first, so you have everything in order. New Jersey Medicare Brokers are unbiased, informed advisors who can find any information you need to move forward with confidence.

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