Special Needs Plans | 2019

 

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.

Medicare uses the term “dual-eligible” for people who qualify for Medicare and Medicaid. Peoples Health offers to dual-eligibles what Medicare calls “special needs plans.”

Our 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).

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.

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 up to $200 every three months*
  • Free respite care sessions for members with Alzheimer’s disease or dementia*
  • 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

Beginning January 1, 2019, dual eligible beneficiaries may request enrollment 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 following receipt of an enrollment request.

The special election period (SEP) is considered “used” based on the month in which the election is made. That is, if an election is made in March and effective in April, the 1st quarter use of the SEP would be considered “used,” not the 2nd quarter. Once a beneficiary uses the SEP in a given quarter, the beneficiary will have to either wait for the next quarter or qualify for another SEP in that same quarter in order to disenroll or switch to a different plan.

This SEP cannot be used to switch plans between October and December. However, beneficiaries will be able to make changes from October 15 to December 7 during the Annual Enrollment Period (AEP) for the following benefit year.

Click here for more information on enrollment period exceptions.

Questions about special needs plans?

For more information about our special needs plans, please call toll-free to speak with one of our plan representatives at 1-800-978-9765, seven days a week, from 8 a.m. to 8 p.m. TTY users may call 711.