What Happens to Your Medicare Dual-Eligible Special Needs Plan If You Lose Medicaid Eligibility?

The COVID-19 Public Health Emergency (PHE) will expire on May 11, 2023. This could affect millions of people currently enrolled in Medicaid. If you are a Medicaid recipient currently enrolled in a Medicare Dual-Eligible Special Needs plan (D-SNP), it may impact your eligibility.

What Is Happening with Medicaid?

The declaration of the COVID-19 PHE three years ago required states to provide “continuous coverage” to those receiving Medicaid benefits, meaning no one could be disenrolled, even if they no longer qualified. This ensured that people would not lose their health insurance during the pandemic. The end of the PHE means states can begin removing ineligible people from their Medicaid rolls.

How Will You Know Your Medicaid Eligibility Status?

Medicaid is administered by individual states. Each state will determine its criteria and timelines for returning to normal eligibility rules. States will have up to 12 months to implement these changes. In Texas, if you are eligible, you will need to renew your benefits to ensure your coverage will continue.

Texas Health and Human Services has recommended three important actions for you to take now:

1. If you don’t already have one, create an account at YourTexasBenefits.com. This is the quickest way to see when it’s time for you to renew. Plus, you can complete your renewal online.
2. Make sure your contact information is up to date to ensure you receive notices. You will receive notices electronically and by mail in a yellow envelope with the words “Action Required” printed in red.
3. Return all requests for information as soon as possible. You may receive a request to complete an application or renewal form providing additional information. If you don’t respond to these requests, you could lose your coverage.

Texas HHS has prepared a FAQ to answer additional questions.

What Happens If You Lose Medicaid Eligibility?

To qualify for a D-SNP, you must be enrolled in either full coverage Medicaid or one of the Medicare Savings Programs. If you lose your Medicaid eligibility, you will most likely no longer qualify for a D-SNP plan. In this case, you will have a Medicare Special Enrollment Period, during which you can:

• Switch from your current plan to another Medicare Advantage Plan or Medicare Prescription Drug Plan.
• Join a Medicare Advantage Plan or Medicare Prescription Drug Plan.
• Drop your Medicare Advantage Plan and return to Original Medicare.
• Drop your Medicare prescription drug coverage.

This Special Enrollment Period lasts for three months from either the date you are no longer eligible for Medicaid or the date you were notified, whichever is later. It is still unknown if these timelines will be amended to deal with the anticipated high volume of people who will be disenrolled from Medicaid.

Don’t Wait to Understand Your Options

To avoid a gap in your health insurance coverage, it’s important to learn now how the end of the COVID-19 PHE will impact you. If you need help navigating these changes and finding new Medicare coverage for when you no longer qualify for a D-SNP, contact us today. The experienced and knowledgeable team at Medicare Educators is here to help.