SCAN Health Plan Advises Californians Eligible for Medicare and Medi-Cal to Shop Carefully for Special “Dual-Eligible” Coverage and Benefits

(LONG BEACH, Calif.) — California residents who are part of both the Medicare and Medi-Cal programs may be eligible to enroll in a special kind of health plan year-round, even outside of the traditional Medicare Annual Enrollment Period. Called dual-eligible special needs plans (D-SNPs), these are Medicare Advantage plans specifically designed for low-income seniors and others on Medicare.

A D-SNP bundles all covered Medicare and Medi-Cal managed care benefits into a single health plan with care provided through one network of doctors and hospitals. “By organizing all care through one plan, members get peace of mind and the confidence that their care is being coordinated in the most efficient and sensible way,” says SCAN Health Plan Senior Vice President Cathy Batteer. “As we have seen repeatedly, seniors who are part of these types of plans are better able to avoid hospital stays and emergency room visits while receiving the kind of support they need to better manage their overall health.” When choosing a “dual-eligible” plan, Batteer says that individuals should look for the following:

All such plans provide members with all of the benefits they would get from Medicare and Medi-Cal, so look for a plan that also offers extra benefits that can save you money and help you stay well. These could include gym memberships, dental coverage, hearing exams, glasses or contact lenses, and transportation to and from doctors’ appointments.

Look for a health plan that has a high STAR rating for quality as established by the Centers for Medicare & Medicaid Services (CMS). This five-star rating system ranks health plans on a one-to five-star basis, weighing such factors as clinical outcomes, access to preventive services such as screenings and vaccines, managing chronic conditions, preventive care, and consumer satisfaction.

Look for a plan whose members are satisfied with the plan’s performance and are happy with the selection that they made. Medicare measures and reports this every year. You’ll see the rating in the Medicare & You booklet from CMS. You can also ask the plan itself. If their member satisfaction rating is high, they will be proud to tell you!

Look for a plan that helps you manage your health, medications and any diseases you may have. You want a plan that puts the focus on preventing illness and finding problems early because that’s when you have the most treatment options. Before you join ask the plan representative how they help you stay healthy – do they have programs or other tools for their members?

Experience counts, so choose a plan that has a proven track record serving members who have both Medicare and Medi-Cal. It is important that the plan has a deep knowledge of how to serve dual-eligible individuals so they are able to help you with any questions or concerns you might have along the way.

And ask around: Find out which plans have good reputations with doctors, hospitals, members, community agencies and others. Batteer says that dual-eligible Californians should carefully shop for the health plan that best fits their needs so they are able to remain healthy and independent.

SCAN Health Plan is one of the nation’s largest not-for-profit MAPD plans currently serving 170,000 members in California. Further information may be obtained at www.scanhealthplan.com or on Facebook at www.facebook.com/scanhealthplan.

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