Medicare offers health insurance coverage in the state of Colorado to people over the age of 65. However, Medicaid, on the other hand, provides health insurance care coverage for those under 65 who qualify because of a disability.

Medicare is a federally funded and managed program, while Medicaid is known and administered at the state level. Medicaid has the functionality to also provide benefits to qualified low-income residents, except the basic requirements can vary from one state to another.

The Basics of D-SNP in Colorado

Some individuals can qualify for both Medicare as well as Medicaid coverage. Dual Eligible Special Needs Plans (also known as D-SNPs) are a particular kind of Medicare Advantage plan specifically created for those enrollees who are entitled to both Medicaid and Medicare benefits in Colorado. A D-SNP combines Medicare and Medicaid benefits, and limits enrollment to only those who qualify.

Enrollment in D-SNPs is available to all kinds of individuals who are eligible for Medicaid in the state of Colorado. There are further restrictions within each of these categories.

Certain conditions must be met to qualify for enrollment in each D-SNP program.

Colorado Dual eligible enrollees meet the following criteria:

• Should meet the eligibility requirements for both Medicare and Medicaid and are enrolled in both programs.
• Should be over the age of 65 or under 65 with a qualifying disability.
• Should have healthcare concerns that may be more costly than typical.

Fully Integrated Dual Eligible SNPs

To fully integrate and coordinate all the benefits of Medicare and Medicaid for dual eligible beneficiaries, Congress created the Fully Integrated Dual Eligible Special Needs Plans as part of the Affordable Care Act.The purpose of the legislation is to promote the coordination and integration of dual eligible benefits and beneficiaries under a single managed care organization.

To do so, fully incorporated dual eligible SNPs residing in Colorado must meet the following criteria:

• There must be a specialized Medicare Advantage plan made for dual eligible special need individuals.
• Validity to be operational during the next contract year.
• They must have been in continuous operation cycle during the entire previous year.
• They must facilitate access to Medicare and Medicaid benefits as covered in Colorado’s Medicare plan.
• Have a contract with the state’s Medicaid agency that includes coverage for specific benefits including acute, primary and long-term benefits. The capitated coverage must be in line with the state policy.
• They must coordinate the delivery mechanism of Medicare and Medicaid health and long-term care services and benefits. To do so, they should use care management and specialty care networks and methods aligned remotely for high-risk beneficiaries.
• Must swiftly adapt, promote policies and procedures that are approved by CMS and the state of Colorado to both coordinate and integrate member materials and communications, enrollments, grievance process, and appeals processes.

If you are a dual eligible enrollee and have questions about your coverage, contact us at 877.986.6908.

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