Medicare can be complicated, and we know you might have questions. We've created this Frequently Asked Questions page so you can find the answers you need, when you need them. Still have questions? Contact us; we're happy to help.
Dual Special Needs Plans Questions
Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is funded jointly by states and the federal government. Medicare is a federal program. It provides coverage for people age 65 and older, and also some people under age 65 who qualify due to a disability.
Colorado’s Medicaid program is called Health First Colorado.
Medicare Advantage Plans (also known as Medicare Part C) offer an alternative to Original Medicare (also known as Medicare Parts A and B). Medicare Advantage (MA) Plans replace your coverage under Parts A and B, and sometimes include additional coverage. They often (but not always) include a specific network of doctors and health care providers you can use to get care, sometimes at lower costs.
Dual Special Needs Plans, also called D-SNP or dual plans, are health plans for people who have both Medicare and Medicaid. Dual plans combine Medicare and Medicaid into one simple plan. With a dual plan, you still keep the Medicaid benefits you get today. You also get many extra benefits and features than Original Medicare at no extra cost. Dual plans:
- Are designed for people who may need extra help because of disabilities, age, and/or health conditions
- Offer more benefits that Original Medicare
- Come with no additional costs
- Are offered by private insurance companies, like RMHP
Yes. Some people qualify for both Medicare and Medicaid. These people qualify for Medicare due to age (by being age 65 or older) or because they have a disability. They also qualify for Medicaid because they meet the Medicaid requirements in their state.
"Dual eligible" describes individuals who qualify for both Medicare and Medicaid at the same time. Because they are eligible for both programs, they’re called "dual eligible."
In all states, Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states, Medicaid covers all low-income adults below a certain income level.
1. Do you qualify for Colorado Medicaid benefits?
- You are under age 65 and qualify on the basis of disability or other special situation
- You are at least 65 years old and receive Extra Help or assistance from your state
- You must have full Medicaid benefits to qualify for RMHP DualCare Plus. A licensed sales agent can help answer your questions about eligibility
2. Do you have Medicare Parts A and B?
- You’re at least 65 years old, or you’re under 65 and qualify on the basis of disability or other special situations and
- You’re a United States Citizen or a legal resident who has lived in the United States for at least five consecutive years
3. Do you live in the plan's service area?
- For example, you must live in Mesa County to qualify for RMHP’s DualCare Plus plan. A licensed sales agent can help answer your questions about the service area.
4. Do you meet the health requirements?
- This plan is not for individuals who have end-stage kidney failure, also called end-stage renal disease (ESRD).
Medicare is a national health insurance program run by the federal government. It is for people age 65 and older, and also some people under age 65 with certain disabilities.
There are many different plans available other than Original Medicare. An RMHP Medicare Salesperson will be happy to help you find the plan that best fits your Colorado lifestyle.
When choosing a Medicare plan, it's important to first understand the basics. Once you know the types of coverage available, consider your budget. Can you afford a monthly premium, and if so, how much? What prescription drugs do you take? How often do you see the doctor? The answers to these questions will help you narrow down your choices.
Some of your selection comes down to personal preference. Some people prefer to pay a higher monthly premium and have a lower deductible. Others feel comfortable knowing they have an out-of-pocket max in place (i.e., the most you will pay for healthcare in a single year).
If you’re not sure what’s right for you, call us; we're here and are glad to help.
No, it is not a requirement. However, if you decide to decline enrollment in a Medicare Part D drug plan when you are first eligible, you may pay a penalty if you choose to enroll at a later date. We invite our Medicare Members to explore Part D coverage for prescription medications from UnitedHealthcare.
Yes, there are additional resources available. Some organizations from which additional information may be requested include:
Senior Health Insurance Assistance Program (SHIP), Colorado Division of Insurance
Visit the SHIP website [Please note: By selecting this link you will be leaving RMHP.org]
Medicare Ombudsman Office
View more information [Please note: By selecting this link you will be leaving RMHP.org]
An Evidence of Coverage (EOC) for Medicare Cost plans provides more detailed information about:
- Conditions associated with receipt or use of benefits, limitations and exclusions
- Out-of-network coverage: Members of our plan may get services from out-of-network providers. If you get care from an out-of-network provider that is not prior-authorized by RMHP, you will pay the cost-sharing amounts under Original Medicare.
- Grievance, coverage determinations, appeals procedures and exceptions process
- Quality assurance policies and policies and procedures, including medication therapy management, and drug and/or utilization management
- Potential for contract termination
- Beneficiaries' and plan's rights and responsibilities upon disenrollment
RMHP is here to help answer your questions. From October 1 to March 31, we’re here seven days a week from 8:00 a.m. to 8:00 p.m. From April 1 through September 30, you may reach us Monday-Friday during regular business hours at 888-282-1420 (TTY: 711). Para asistencia en español llame al 888-282-1420.Contact us Request information
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