A Humana Dual Eligible Special Needs Plan (D-SNP) may be an option if you have Medicare and qualifying Medicaid coverage. Eligibility, availability and benefits depend on the specific plan, your service area and your Medicaid status. This overview does not confirm that a plan is available to you or that you qualify.
Start with the eligibility questions
A D-SNP is a type of Medicare Advantage plan. You need Medicare Parts A and B, must live in the plan's service area, and must meet its special eligibility conditions. Medicaid categories and the help they provide differ. Ask the plan to verify which categories it accepts using your current state eligibility information.
Having a Medicaid card does not establish eligibility for every D-SNP. Likewise, having Medicare does not automatically enroll you in Medicaid or in a Humana plan. Keep your state renewal notices and report changes as required.
Review the actual plan documents
| Document or information | Question to answer |
|---|---|
| Plan name, identification number and year | Are you reviewing the exact plan available at your address? |
| Summary of Benefits and Evidence of Coverage | What services, limits, approvals and member costs apply? |
| Provider directory | Are your doctors, hospital and preferred facilities in the network? |
| Part D formulary and pharmacy directory | Does the coverage fit your prescriptions and pharmacy? |
| State Medicaid eligibility notice | Which assistance category do you have, and when must it be renewed? |
Understand costs and additional benefits
D-SNPs include Medicare Part D coverage and help coordinate care. Some offer additional benefits, but the services, eligibility conditions and limits are plan-specific. Ask for details before relying on dental, vision, hearing or any allowance shown in advertising.
Your Medicaid assistance category can affect what you owe. CMS distinguishes D-SNPs with and without Medicare zero-dollar cost sharing. Do not assume every member has identical costs or that a zero-dollar plan premium eliminates all other expenses. Request an explanation of your own premiums, deductibles and service costs.
Check your care before switching
Verify the network with both the plan and the provider's office. Ask about ongoing care, referrals, prior approvals and care coordination. Review how any proposed change interacts with your Medicaid managed care coverage. Keep a record of the plan representative's answers.
Confirm when enrollment can take effect
An enrollment period must apply before you can join or change plans. Some people with Medicare and Medicaid qualify for special enrollment opportunities, but the available action depends on their situation and the plan. Ask Medicare or the plan to confirm the applicable period and effective date before ending or replacing coverage.
Prepare for an insurance conversation
Bring your Medicare and Medicaid information, current plan documents, provider names and questions. A Licensed Insurance Agent can explain the plans the agency represents and help check documents. Final eligibility and benefit determinations belong to the appropriate program or plan; this article does not promise enrollment, savings or a particular benefit.
Continue with a related question
- Medicare and Medicaid: Different Programs, Coordinated Help
- How to Find and Verify a Medicare Provider
- Medicare Part D Coverage Stages: The Current Structure