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5 key things to know when picking a dual health plan?
Posted: January 17, 2020
Last updated date: December 06, 2022
Health and health insurance terms are confusing enough. But when you have both Medicaid and Medicare it adds a whole new level. At UnitedHealthcare, the promise to help make things simpler guides everything we do. In this article, we want to make it simpler to understand some of the key points about dual health plans.
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Everything you need to know about Dual Special Needs Plans in one, convenient guide.
1. What do “dual” and “dual-eligible” mean
Dual is just another way of saying “two” or “both.” In the case of dual health plans, dual means that these plans are for people who have both Medicaid and Medicare. “Dual-eligible” is a term that describes people who are eligible, or who qualify, to receive both Medicaid and Medicare benefits. These people are also known as “dual-eligible.”
2. Dual health plan or dual special needs plan? What’s the difference?
Zip. Zero. Nada. There’s no difference. Whether you use dual plan, dual health plan, dual special needs plan or even the shorthand DSNP, all these terms mean the same thing. They describe the type of health plan that’s specially designed to meet the needs of people who have both Medicaid and Medicare.
3. Does a dual health plan combine Medicaid and Medicare into one?
This point confuses a lot of people, but the answer is no. A dual health plan doesn’t replace your Medicaid plan. You’ll keep your Medicaid plan, and you’ll still get all the same Medicaid benefits you get now. A dual health plan is a type of Medicare Advantage plan. It will replace your current Medicare plan. Plus, it includes prescription drug coverage and many other benefits and features you don’t get with Original Medicare.* For more details, view the "Do I Lose My Medicaid Benefits?" article.
4. When can you enroll in a dual health plan?
There are rules that control when you can enroll in a dual health plan. When you first become eligible for Medicare, you’ll have an Initial Enrollment Period (IEP). Your IEP is the 7-month period that:
- Begins 3 months before the month you turn 65
- Includes the month you turn 65
- Ends 3 months after the month you turn 65
If you have a qualifying life event, you can enroll using a Special Enrollment Period (SEP). Moving or losing your insurance coverage are just 2 examples of qualifying life events. But the time you have to enroll may be different depending on the reason for your SEP.
There’s also the Medicare Annual Enrollment Period (AEP). AEP runs from October 15 thru December 7 every year. Anyone who’s eligible can enroll in or switch their Medicare plan during AEP. That includes if you want to switch from just Original Medicare to a dual health plan.
Once you enroll, you don’t need to renew a dual health plan. As long as you stay eligible, your dual health plan will renew automatically each year. But you do need to recertify for Medicaid every year to stay qualified for a dual health plan.
5. Where does UnitedHealthcare Dual Complete® fit in?
“Dual Complete” is the brand name for the dual health plans offered by UnitedHealthcare. UnitedHealthcare has been serving people with special heath care needs for more than 40 years. Today, UnitedHealthcare serves more dual-eligible members in more states than any other health care company.1
Not finding what you’re looking for?
UnitedHealthcare has a free online listing of thousands of medical terms and their meanings. It’s called Just Plain Clear and it’s the largest glossary of its kind.
TIP: Add the link to your favorites list so you can easily find the library any time you need in future.
See UnitedHealthcare plans in your area
Dual-eligible or Medicaid plan benefits can change depending on where you live. Search using your ZIP code to find the best plan to meet your health care needs.
*Benefits and features vary by plan/area. Limitations and exclusions apply.
1CMS market share of enrollment data as of August 2021.