How a Duals Plan Could Help Your Qualifying Loved One


How a Duals Plan Could Help Your Qualifying Loved One


Approximately 12.1 million people are simultaneously enrolled in Medicare and Medicaid — known as “dual-eligible” beneficiaries. You might be wondering: how do you know if your loved one qualifies for a duals plan? And what does the enrollment process look like for those who are eligible? 

Laura Esslinger, Vice President of the Duals Segment at Aetna Medicare, sat down with us virtually to answer these important questions and provide her advice to caregivers with loved ones who may be dual-eligible. Here’s what she had to say: What does it mean to be dual eligible? How does a duals plan differ from traditional Medicare and other types of Medicare Advantage plans?

Laura: By definition, being dual-eligible means that you qualify for both Medicare and Medicaid. Those who qualify are normally two groups of people – either low-income seniors or people living with a disability. Most people qualify for Medicare once they reach age 65, but some younger adults with disabilities also qualify. Your Medicaid eligibility is based on your income level and some additional standards. If you meet the separate eligibility requirements for both Medicare and Medicaid, you’re considered dual eligible. 

The coverage level for dual-eligible beneficiaries can vary based on whether they’re fully or partially dual eligible. It’s important to understand your loved one’s eligibility to know the level of support they’ll receive from their health plan. If your loved one is dually eligible or qualifies for “Extra Help,” a specialized plan can provide access to enhanced benefits and may help coordinate Medicare and Medicaid benefits. What is a D-SNP? What does the enrollment process look like for those who are eligible?

Laura: A D-SNP is one of the most common types of duals plans offered, formally known as a Dual Eligible Special Needs Plan. It gives you all the benefits of Original Medicare (Part A hospital insurance and Part B medical insurance), plus supplemental benefits that you don’t typically receive from Medicaid or Original Medicare.

There are a few factors to consider as to when you can enroll in a D-SNP plan. If you’re newly eligible for Medicare and Medicaid, you can enroll any time of the year. If you already have both Medicare and Medicaid, or you already have a D-SNP, you can switch plans during a Special Enrollment Period (SEP) or during the Annual Enrollment Period (AEP) October 15-December 7. This guidebook can be a great resource to help you and your qualifying loved one understand the basics of a D-SNP plan (check out page 8 to remind your loved one of important dates for when to enroll). Are there any out-of-pocket costs associated with a duals plan?

Laura: There are few-to-no out-of-pocket costs associated with duals plans. This is especially critical as most of our members are on fixed incomes, so it’s important to maximize their cost savings. For example, most of Aetna’s 2022 D-SNP plans offer prescription drugs at no out-of-pocket cost as well as access to additional benefits, such as a healthy foods or utilities benefits card. What local resources are available to support duals members?

Laura: All duals members have access to the resources available through a Medicare Advantage plan, including Part D prescription drug coverage. Aetna D-SNP members also have access to CVS HealthHUB® locations, which offer everything from expanded health services to telehealth visits to pharmacy support. 

Most D-SNP plans also offer the support of a dedicated interdisciplinary care team to help members maximize their benefits and get the care they need. At Aetna, our member’s care team includes a care coordinator, nurse care manager, social worker and a member advocate. The personalized care team is designed to help members understand their own unique care needs, develop care plans with doctors, and coordinate visits with health care providers to support continuity of care. They also can help address barriers to seeking care by setting up transportation to and from appointments and helping members access their state Medicaid benefits. Where can potential members who need help understanding their options go for more information?

Laura: You can talk to a licensed insurance advisor or trusted broker to help you learn about the different plans available in your area. These professionals are often available to meet over the phone or by video call. Many insurers also offer local in-person seminars to learn more about plans and allow for questions. Given the evolving state of COVID-19, many of these seminars are offered online so that you and your loved one can join from the comfort of home. What final advice do you have for caregivers with loved ones who qualify for a duals plan?

Laura: It’s critical to take your loved one’s total health needs into account. Make sure to ask questions about the nontraditional benefits available through their health plan, such as transportation, access to healthy foods, and other services. These are key components to helping your loved one stay active and engaged in their community.

Above all, don’t forget to engage with your loved one’s care coordinator! They can be a great resource for helping members and families understand their benefits to achieve better health. Thank you, Laura, for taking the time to speak with us. We hope that caregivers and their loved ones find this conversation helpful.

To learn more about Aetna duals plans, visit the Aetna D-SNP site or call 1-844-588-0135. 

For more information visit: or call 844-588-0135 (TTY: 711), 7 days a week, 8 AM to 8 PM. A licensed agent will answer your call.

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