New Medicare Plans for 2021 will help needy Nevada residents

If you are covered by both Medicare and Medicaid, you may be happy to learn that Medicare has approved a new type of plan for residents in Clark and Washoe counties.

Dual Eligible Special Needs Plans (DSNP) are being introduced to both counties for the 2021 year for those who have both Medicare and Medicaid. Residents can enroll during the annual Medicare enrollment period from Oct. 15 – Dec. 7, 2020. An estimated 50,000 residents are eligible in Clark County and about 16,000 in Washoe County.

A Dual Special Needs Plan (DSNP), which is a Medicare Advantage plan, provides coverage for medical and prescription drug coverage and is designed to provide additional services for those with the highest needs. These additional services are above what you could receive from an individual Medicare or Medicaid plan.

DSNP plans are provided by certain health insurance carriers through a Medicare Advantage plan. The plans use carriers’ robust network of providers and not a state Medicaid list of providers.

There are an estimated 2.6 million people enrolled in DSNP plans in 2020 throughout the United States, with the enrollees being the highest need populations in either program. Those who are eligible typically can enroll with a zero premium. There are an estimated 60,000 Clark County residents who may qualify for these plans.

In Clark County, there are four carriers offering a new DSNP plan for 2021 with various additional benefit levels. One plan includes coverage of $4,000 in comprehensive dental fees, including dentures. Another plan includes a $0 co-pay on prescription drugs and offers a monthly food credit. And the plans offer coverage for vision, hearing and transportation costs.

The overall goal of a DSNP plan is to provide coordinated health care and services to those who can benefit the most from the special expertise of the plans’ providers and focused care management.

“These plans offer a significant improvement in access for a vulnerable population and will immediately help those who have delayed necessary care," said Mike Yasi, Advocate Health Advisors Director of National Sales for DSNP. “These special needs plans also seek to reduce overall healthcare costs by aligning carriers and providers with state-run programs as well."

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Most people have heard of Medicare and Medicaid. Medicare provides health benefits for people over age 65 as well as people younger than 65 who qualify due to a disability. Medicaid provides health benefits for people with low income. Eligibility and levels vary by state.

About 30% of people eligible for Medicare have chosen to get their Medicare benefits through what is known as a Medicare Advantage plan, which is a plan offered by a private health insurance company approved by the federal government. Medicare Advantage plans combine a person’s Medicare benefits, including doctor and hospital coverage as well as Part D prescription drug coverage in most cases. They also can offer benefits beyond what is available with Original Medicare, such as dental, vision, hearing coverage and more.

Why would someone consider a DSNP?

DSNPs can make it much simpler for members to navigate the health care system. DSNP plans encourage everyone involved – including primary care doctors, specialists, hospitals and care managers – to work together, which can help improve members’ health as well as their experience with the health care system.

DSNPs usually offer benefits, including:

• Dental care, such as exams, x-rays, cleanings, fillings, crowns and extractions and in some cases even dentures
• Access to a health products catalog to order over-the-counter products such as vitamins and first-aid supplies
• Hearing exams and access to hearing aids
• An annual eye exam and a credit for eyewear
• No-cost transportation to health care visits and pharmacies.

When can a person enroll?

The Medicare Annual Enrollment Period – Oct. 15 – Dec. 7 -- is a great time for people to review their health plan options with a licensed health insurance agent and see if they qualify for a DSNP. However, people who qualify for a dual plan can enroll or switch to a new plan at certain times throughout the year.

~ Mike Yasi is Director National Sales-DSNP for Advocate Health Advisors, a brokerage specializing in helping those who are Medicare eligible. Yasi can be reached at mike.yasi@advocatehealthllc.com.