August 2022

Dear Colleague,

Individuals with intellectual and developmental disabilities (IDD) who receive both Medicaid and Medicare are known as "dual eligibles." In the past, I distributed three fact sheets with frequently asked questions (FAQs) about dual eligibility.  This email is focusing on Dual Eligible Special Needs Plans (D-SNPs), which are Medicare managed care plans established specifically for people who have both Medicaid and Medicare. If anyone is considering enrolling a dual eligible with IDD into a D-SNP, it will be helpful to read The Arc of New Jersey's fact sheet on this topic.

Dual Eligibles and Special Needs Plans (D-SNPs)

Please keep in mind that when an individual enrolls voluntarily in a D-SNP, he/she must use only the health care providers and services -- including the drug plan -- that are affiliated (i.e., in-network) with that D-SNP. Therefore, before choosing to enroll in a D-SNP, the caregiver should check carefully to be certain that the doctors, hospitals, labs, and pharmacies that the individual wants to use are affiliated with that D-SNP. This includes being certain that the medications that were covered under the Medicare Part D drug plan will be covered in the D-SNP's formulary.

After enrolling voluntarily in a D-SNP, if an individual is treated by an out-of-network provider, the individual will receive a bill for the full cost of that service -- and neither Medicare nor Medicaid will cover that cost.

You may be interested in two other fact sheets for dual eligibles with IDD that The Arc of New Jersey has disseminated:

General Information for Dual Eligibles

Dual Eligibles and Prescription Medication