How Medicare and Medicaid Work Together
Some Peoples Health plans offer additional benefits for people with both Medicare and Medicaid
If you have Medicare and get additional medical assistance from the state of Louisiana or Louisiana Medicaid, you could be getting even richer benefits than you’re getting now.
Special Needs Plans
Medicare uses the term “dual-eligible” for people who qualify for Medicare and Medicaid. Peoples Health offers dual-eligibles what Medicare calls “special needs plans.” Taken together, these are called Dual-Eligible Special Needs Plans (D-SNP).
Peoples Health special needs plans are available to anyone who has both Medicare and medical assistance from the state or Louisiana Medicaid. Some companies that offer these special needs plans require dual-eligibles to have full coverage from Medicaid to join the plan. Peoples Health special needs plans, however, are available to those with full Medicaid coverage as well as those who have partial Medicaid coverage (for example, Medicaid pays their Part B premium).
If you have Medicare and Medicaid, ask us about:
- Free comprehensive physical exams
- Free tests and screenings
- Free rides to doctors’ appointments*
- Free fitness center membership*
- Free meals after inpatient hospital stay
- Free over-the-counter health-related items
- Free respite care sessions for members with dementia, including Alzheimer’s disease*
- Free hearing services including hearing aids*
- Routine vision coverage*
- Routine dental coverage including dentures*
- Prescription drug coverage, including coverage for brand drugs
- A Peoples Health plan ID card that’s widely accepted and easy to use
*May not be available with all special needs plans
Many people with Medicaid have faced tremendous hurdles to achieve good health throughout their lives. We’ve designed our special needs plans to help lower or remove those hurdles through enhanced benefits and coordinated care.
Dual-eligibles have a special enrollment period (SEP) that allows them to enroll in a different plan one time during each of the first three quarters in a calendar year:
January to March
April to June
July to September
The effective date of the individual’s enrollment in their new plan would be the first of the month after the plan received an enrollment request.
The SEP is considered “used” based on the month in which the enrollment request is made. For example, if an enrollment request is made in March and is effective in April, the individual has used the first-quarter SEP, not the second-quarter SEP. Once a SEP in a given quarter is used, the individual will have to either wait for the next quarter or qualify for another SEP in that same quarter in order to switch to a different plan.
This SEP cannot be used to switch plans between October and December. However, individuals can make changes from October 15 to December 7 during the Annual Enrollment Period for the following year.
Questions about special needs plans?
For more information about our special needs plans, please call to speak with one of our plan representatives toll-free at 1-800-978-9765, seven days a week, from 8 a.m. to 8 p.m. TTY users may call 711.