Essence Dual Advantage (HMO D-SNP)

Dual Eligible Special Needs Plans (D-SNP)

Health plans for people with both Medicare and Medicaid

What’s the difference between Medicare and Medicaid? If you’re not sure, we can help.

Medicare is a federal program that provides health benefits for people over age 65, as well as people younger than 65 who qualify due to a disability. Medicaid, on the other hand, is managed at the state level and provides health benefits for people with low income, but the rules to qualify change from state to state.

You can have both Medicare and Medicaid at the same time

Some people have both Medicare and Medicaid. If so, they could be “dual eligible.” That’s where dual special needs plans come in. Dual special needs plans work together with an individual’s Medicaid plan and cover eligible doctor visits, hospital stays and prescription drugs. If you have Medicare and Medicaid, chances are you could qualify for a dual plan.

Dual plans offer money-saving extra benefits at no additional cost

Dual plans go beyond either Medicaid or Original Medicare alone. You’ll still get to keep your Medicaid benefits and have additional D-SNP features with a dual special needs plans. And better yet, with a dual plan, you could be eligible for many more money-saving extra benefits than Original Medicare offers at no additional cost.

These extra benefits may include:

• Comprehensive Dental Care
• Eye exams, plus credit for eyewear
• Hearing exams, plus hearing device allowances
• Rides to health care visits and the pharmacy
• Flex Card for OTC Items and Healthy Groceries (if qualified) 

As an added bonus, people who are dual eligible can usually enroll for no monthly premium and receive Personal Emergency Response System coverage, making a dual special needs plan a low-cost, high-value option.

Want to see if you qualify for these money-saving extra benefits and features?

You can enroll in our dual special needs plan if you meet the following criteria:

• Must be eligible for Medicare Part A and be enrolled in Medicare Part B
• Must qualify for one of the following Medicaid categories:
  • Qualified Medicare Beneficiary (QMB): You’re not eligible for full Medicaid benefits, but Medicaid pays all copays and co-insurance for your Medicare-covered services. Medicaid also pays your Part A premium (if one is required), Part B premium and deductibles.
  • Qualified Medicare Beneficiary Plus (QMB+): You’re eligible for full Medicaid benefits, and Medicaid pays all copays and co-insurance for your Medicare-covered services. Medicaid also pays your Part A premium (if one is required), Part B premium and deductibles.
• Must live in the city of St. Louis or the Missouri counties of Jefferson, St. Charles or St. Louis

Want more information? We can help.

Request your FREE D-SNP Information Kit