More Coverage Under One Umbrella
If you are eligible for Medicare and Medicaid, our Dual-Eligible Special Needs Program (D-SNP) can give you enhanced benefits. We can provide extra benefits, better benefit coordination, and more value! Our Wellcare D-SNP Medicare Advantage Plan puts you and your health first.
What is D-SNP?
D-SNP stands for Dual-Eligible Special Needs Plan (D-SNP). Our D-SNP plans are designed for individuals who qualify for both Medicaid and Medicare. Dual enrollment provides additional support and benefits at no extra cost for people who qualify for both Medicare and Medicaid coverage.
PA Health and Wellness Medicare is called Wellcare. Members that have Wellcare as their Medicare coverage have their same PA Health and Wellness Care Manager who works seamlessly across their Medicaid and Medicare. The member continues to receive all their Medicaid benefits plus the added convenience of having their care managed in one place.
Why Enroll in a D-SNP Plan?
It is common to have Medicare and Medicaid and be enrolled with different plans. This can be confusing. It can be hard to determine which plan covers certain doctor visits or medications. Having D-SNP simplifies your coverage. When you enroll with a Dual-Eligible Special Needs Plan (D-SNP), your healthcare is managed all in one plan. This makes everything simpler for you to get the care you need. There will be no disruptions to your benefits.
By aligning your care, you get the full benefits of services under one plan. Dual enrollment provides comprehensive coverage. Where your Medicaid coverage stops, your Medicare coverage begins, so you can get the care you need with ease. Having DSNP simplifies your coverage.
Call us today to learn more and enroll in our Wellcare Dual Eligible Special Needs Plans (D-SNP) at 877-823-8267 from 8 am - 8 pm, 7 days a week.
Value of One Plan with D-SNP
With our D-SNP plan, ONE company coordinates your health care and daily living needs. This results in:
- Integrated care coordination, which provides a simplified experience. An integrated health plan can more easily work with different providers to improve your care.
- Enhanced benefits and more value.
- One plan that puts you and your health first!
Quality health care is more than just treatment. It is your entire experience with providers and the health plan:
- Streamlined payment of Medicare cost sharing simplifies claims submission and payment.
- Single source of authorizations for covered services.
D-SNP plans provide extra health benefits at minimal to no cost to you:
- Extra benefits that aren’t covered by Medicare Part A or Part B (Original Medicare)
- Vision, Dental and Hearing Benefits
- Coverage for prescription drugs
- Allowance for OTC, Healthy Foods, Gas (pay-at-pump), Home and Bathroom Safety Items, Rent and Utility Assistance
- Non-emergent ground transportation
- My Wellcare Rewards Program
The Importance of D-SNP
The Centers of Medicare and Medicaid Services (CMS) are changing some rules around D-SNP. What is changing? Starting in 2027, if signing up for a D-SNP for the first time, consumers must pick the same company for both Medicaid and Medicare. People who are already enrolled can keep their current plan for now.
By 2030, everyone must have the same company for both Medicaid and Medicare. This is called being fully aligned.
If you are already enrolled in both Medicare and Medicaid, you have until 2030 to align your healthcare coverage and enroll in one company. If not fully aligned by 2030, you risk being disenrolled.
The purpose of this change is to improve integration, reduce fragmentation, and ensure unified appeals through aligned enrollment. While it may sound confusing, it will actually make things easier for you and your healthcare providers. Members will get benefits that work together. Your provider will be able to deliver a smoother experience.
To read more about the new rule, visit the CMS website.
Medicaid is a joint federal and state public health insurance program providing coverage to low-income Americans. Coverage can include long-term supports and services, doctor appointments, prescription drugs, and more.
Medicare is a federal health insurance program covering seniors and certain disabled individuals. Medicare is comprised of four parts.
- Part A, Hospital insurance and associated costs
- Part B – Medical insurance (physician services, lab and x-ray services, outpatient and other services)
- Part C – Medicare Advantage Plan (offered privately)
- Part D – Prescription drug costs
Dental: $0 copay for diagnostic, preventive, comprehensive dental. Includes dentures & implants.
Vision: $300–$500 (depending on plan) combined allowance toward contacts and glasses per year.
Hearing: $1,000 allowance per ear, per year with 3-year warranty and 2-year battery supply.
Transportation: 60 one-way rides to approved health care locations for non-emergency care.
Personal Emergency Response System: Device per lifetime plus monthly fee for 24/7 emergent and non-emergent needs.
Fitness: Fitness center membership, on-demand exercise programs, 1:1 well-being coaching, and home fitness kit.
SSBCI Eligible Members Receive
The ability to use their Spendables® Card allowance of $219 or $83 monthly (depending on plan) toward OTC items, gas pay-at-the-pump, healthy food, home improvement and safety items, rent & utility assistance, and pest control. Rolls over monthly.
Gas Pay-at-the Pump
Helps members maintain independence and reduced transportation costs
Healthy Food
Supports dietary needs and reduces food insecurity, promoting better health outcomes
Home Assistance and Safety Items
Helps members maintain a healthy and safe living environment, reducing accident risks. The benefit includes installation costs
Rent and Utilities Assistance
Reduces financial stress and supports members in maintaining stable housing
Pest Control
Allows for decreased exposure to allergens and disease-carrying pests that can worsen chronic health conditions
*SSBCI = Special Supplemental Benefits for the Chronically Ill. CMS criteria must be met.
*For a sample of the OTC and Healthy Foods Catalog.
*Benefits mentioned are a part of Special Supplemental Benefits for the Chronically Ill. Not all members will qualify. In addition to being high-risk, you must have one or more of the following chronic conditions: cancer, cardiovascular disorders, chronic and disabling mental health conditions, chronic lung disorders, diabetes. There are other eligible conditions not listed. Eligibility for this benefit cannot be guaranteed based solely on your condition. All applicable eligibility requirements must be met before the benefit is provided. For details, please contact us or see the plan’s Member Handbook.
OVER THE COUNTER ITEMS
These are products available in-store & online. Fulfilled by McKesson & Uber Eats.
DENTAL, VISION, HEARING
Out-of-pocket costs and coverage for service beyond base plan limits for services listed by plan.
How Members Earn Rewards
Complete eligible preventive health activities:
- annual wellness exams
- screenings (ex: cancer, diabetes)
- immunizations
Rewards dollars are added to the member's account after activity verification.
Personal Emergency Response System (PERS)
Medical Alert Systems can provide peace of mind if you have a medical emergency.
As a member of Wellcare, you are covered for one personal emergency response device per lifetime and the monthly fee at no additional cost. A personal emergency medical response device provides peace of mind and 24/7 response to your emergent and non-emergent needs.
Members can choose from:
- A traditional "hard-wired" PERS system that is connected via landline. For hard-wired systems, an existing landline phone is required.
- A wireless PERS system.
- Wearable device options.
At Home or On the Go
- At-home PERS may require an existing landline.
- Variety of devices for use both in the home and on the go
- Feel safe 24/7/365
Prior Authorization may be required
Post-Discharge meals:
- Member is released from an inpatient hospital or nursing facility
- Eligible Member is referred for meals either by discharge staff or their care manager (telephonic coordinator)
- Authorization created if a member would like to receive meals
- Vendor receives authorization and dispatches 2 weeks of meals.
Nutritional Shakes:
As medically appropriate, a member has the option to receive nutritional shakes instead of a solid meal, as part of their post-acute or chronic meals benefit. The shakes come in cases and each shake counts as one meal. The rest of the meals will be fulfilled with a frozen or refrigerated meal.
Non-emergency medical transportation (NEMT)
Non-emergency medical transportation (NEMT) are services provided to individuals who require medical assistance but do not have a medical emergency, typically utilized for patients who need transportation to and from scheduled medical appointments, such as doctor's visits, diagnostic tests, or therapy sessions.
Covered Transportation Modes
- Sedan/Taxi
- Ride share services
- Wheelchair van
Members can schedule rides to and from various plan approved health-related locations, including:
- Behavioral Health
- Dental Services
- Dialysis
- Laboratory Services
- Primary Care Physician
- Medical Screening/Testing Appointments
- Pharmacy
- Physical therapy
- Specialists
- Vision Services
Here For Your Health
If you have any questions, click the button below to contact us!