Dual Eligibility (D-SNP)

Medicare & Medicaid Dual Eligibility in Ohio

If you qualify for both Medicare and Ohio Medicaid, you may be eligible for a Dual Eligible Special Needs Plan (D-SNP), a specialized Medicare Advantage plan that coordinates both programs into one card with significant extra benefits. Seniors Primero Insurance Agency helps Ohio beneficiaries in Franklin, Cuyahoga, Hamilton, Montgomery, Summit, and Lucas Counties, and across the state, choose the D-SNP that fits their doctors, medications, and budget through convenient phone appointments.

Who is "dual eligible" in Ohio?

A "dual eligible" beneficiary is someone enrolled in both Medicare (Part A and/or Part B) and Ohio Medicaid. Ohio Medicaid is administered by the Ohio Department of Medicaid, with applications processed through Ohio Benefits and your county Department of Job and Family Services. Dual eligibility ranges from full dual (Medicaid covers Medicare premiums, cost sharing, and long term services) to partial dual categories such as QMB, SLMB, and QI.

Ohio Medicaid pathways for seniors

• QMB (Qualified Medicare Beneficiary), Medicaid pays your Part A and Part B premiums, deductibles, coinsurance, and copays.
• SLMB (Specified Low income Medicare Beneficiary), Medicaid pays your Part B premium.
• QI (Qualifying Individual), Medicaid pays your Part B premium for those with slightly higher incomes.
• Full Ohio Medicaid, covers long term care, home and community based waivers such as PASSPORT, and Medicare cost sharing.

What is a D-SNP plan in Ohio?

A Dual Eligible Special Needs Plan (D-SNP) is a Medicare Advantage plan built exclusively for people on both Medicare and Medicaid. Ohio has moved its integrated care model to Next Generation MyCare Ohio, which pairs your Medicare D-SNP with your Ohio Medicaid managed care plan so one care team coordinates everything. Most Ohio D-SNPs offer a $0 monthly premium, $0 or very low copays, and built in Part D prescription drug coverage.

Extra benefits Ohio D-SNP plans typically include

• Monthly grocery, OTC, and utility flex card allowances for qualifying members.
• Comprehensive dental, cleanings, fillings, extractions, crowns, and dentures.
• Vision exams and eyewear allowance.
• Hearing exams and aids.
• Non emergency medical transportation to doctor visits and the pharmacy.
• Care coordination through a personal care manager.
• Fitness memberships such as SilverSneakers.

When can you enroll in a D-SNP?

Dual eligible beneficiaries get a Special Enrollment Period (SEP) that lets them join, switch, or drop a Medicare Advantage / D-SNP plan once per quarter during the first three quarters of the year, in addition to the Annual Enrollment Period (October 15 to December 7). If your Ohio Medicaid status changes, you generally get another chance to change plans.

How Seniors Primero helps

We're a licensed Ohio Medicare agency that works with dual eligible seniors every day. We confirm your Medicaid level, compare D-SNP plans from top Ohio carriers side by side, run your medications against each plan's formulary, and stay with you year after year. Our consultations are at no cost and no obligation.