Our Dual Advantage Special Needs Plan (D-SNP)
The Memorial Hermann Dual Advantage Special Needs Plan (D-SNP) is for people that have both Medicare and Medicaid. For those eligible, it’s an all-in-one plan with a $0 premium that combines your Medicare Part A and Part B benefits, your Medicare Part D prescription drug coverage, your Medicaid benefits, as well as extra benefits not provided by either Medicare or Medicaid.
Here’s an overview of the plan benefits that are included in our Dual Advantage Special Needs Plan. For a more detailed Dual Advantage benefit grid, please click here.
| Benefits & Features* | Benefits You May Have Now: | Benefits with Memorial Hermann Dual Advantage HMO D-SNP |
|---|---|---|
| Medicaid Benefits | Yes | Yes |
| Hospital Stays | Yes | Yes |
| Doctor and Outpatient Care | Yes | Yes |
| Prescription Drugs | Yes | Yes |
| More Prescription Drug Coverage | -- | Yes |
| Preventative and Comprehensive Dental Coverage | -- | Yes |
| Vision and Hearing Allowances | -- | Yes |
| Over-the-Counter Benefit1 | -- | Yes |
| Transportation Benefit2 | -- | Yes |
| Meals Benefit | -- | Yes |
| Fitness Benefits and Wellness Program - At No Extra Cost | -- | Yes |
| Virtual Care options such as Teladoc, Evisits and the Memorial Hermann Virtual Clinic | -- | Yes |
* Benefits and features vary by plan. This information is not a complete description of benefits. Please call us at (833) 796-1229 for more information.
1 For the Over-the-Counter Benefit, Medline At Home provides over-the-counter products covered under this specific plan at no additional cost to you.
2 For Transportation Benefit, click here for more information or visit ModivCare to schedule a ride. (Please note that by clicking on this link, you will be leaving Memorial Hermann Advantage website.)
Eligibility for the Memorial Hermann Dual Advantage Special Needs Plan (D-SNP)
To be considered Dual-eligible you will need to live in Harris, Fort Bend, or Montgomery counties, and meet one of these basic requirements:
- Be over 65 and have both Medicare and Medicaid
- Or, be under 65 with a qualifying disability
Individuals who meet one of these basic requirements must also be enrolled in Medicare Part A and/or Part B and receive full Medicaid benefits and/or assistance with Medicare premiums or cost sharing through one of the following “Medicare Savings Program” (MSP) categories:
Qualified Medicare Beneficiary (QMB)
You get Medicaid coverage of Medicare cost-share but are not eligible for full Medicaid benefits. Medicaid pays your Part A and Part B premiums, deductibles, coinsurance and copayment amounts only. You pay nothing, except for Part D prescription drug copays.
Qualified Medicare Beneficiary Plus (QMB+)
You get Medicaid coverage of Medicare cost-share and are also eligible for full Medicaid benefits. Medicaid pays your Part A and Part B premiums, deductibles, coinsurance and copayment amounts. You pay nothing, except for Part D prescription drug copays.
Specified Low-Income Medicare Beneficiary Plus (SLMB+)
Medicaid pays for Part B premium and full Medicaid benefits are provided.
Full Benefits Dual Eligible (FBDE)
Medicaid provides full Medicaid benefits and may provide limited assistance with Medicare cost-sharing.
If your category of Medicaid eligibility changes, your cost share may also increase or decrease.
Enrollment Periods for the Memorial Hermann Dual Advantage Special Needs Plan (D-SNP)
If you’re newly eligible for Medicare and Medicaid, you can enroll any time of the year, with no restrictions. If you already have both Medicare and Medicaid, or are already enrolled in a D-SNP, you can switch plans up to four times a year:
- Special Enrollment Period (SEP) 1: January 1 – March 31
- Special Enrollment Period (SEP) 2: April 1 – June 30
- Special Enrollment Period (SEP) 3: July 1 – September 30
- Annual Election Period (AEP): October 15 – December 7
This plan has a network of doctors and pharmacies
Memorial Hermann Dual Advantage Special Needs Plan (DSNP) has a network of doctors, hospitals, pharmacies, and other providers. If you use providers who aren’t in our network, the plan may not pay for these services.
You have access to Care Managers. Care Managers are nurses or care coordinators who support your health and well-being by providing additional services including acute and chronic-care management, telephonic and in-person health support; assistance in coordinating Medicare and Medicaid benefits, educational resources and workshops and support for families and caregivers.
This plan is a Dual Eligible Special Needs Plan (D-SNP). Your ability to enroll will be based on verification that you are entitled to both Medicare and medical assistance from a state plan under Medicaid.
Memorial Hermann Dual Advantage HMO, provided by Memorial Hermann Health Plan, Inc., is a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal.
Memorial Hermann Advantage complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.
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