Medicare Dual Special Needs Plan (D-SNP)
| Date: | December 18, 2024 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) |
| To: | Health Plan Providers |
| Type: | Regulatory |
| Subject: | Medicare Dual Special Needs Plan (D-SNP) |
| Business: | Medi-Cal Managed Care |
Starting January 1, 2026 and subject to regulatory approval, Health Plan will be offering a Medicare Dual Special Needs Plan (D-SNP). D-SNPs are Medicare Advantage plans in California available to members with both Medicare and Medi-Cal (also known as dual eligibles or Medi-Medi). Dual eligible members receive both Medicare and Medi-Cal benefits from one plan, offering integrated care and additional benefits beyond what Medicare and Medi-Cal covers.
As a current Medi-Cal provider, you have the option to join our D-SNP provider network. This can help to ensure your Medi-Cal patients can continue to choose you as their provider when they become eligible for Medicare.
Key Benefits of D-SNP for Providers:
- Integration of Benefits and Services: One single plan, one ID card, and one set of benefits. Coordination of services will be simplified, and you will only need to work with one plan, not two.
- One Plan, One Point of Contact: There will be one point of contact for both Medicare and Medi-Cal services. Most claims will be processed by the same health plan, simplifying your billing and payment processes.
- Comprehensive Support for Your Patients: D-SNP members will have access to enhanced services, including specialized care coordination and interdisciplinary care teams.
Key Benefits of D-SNP for Members:
- Holistic Care Under One Plan: Members receive all Medicare Parts A, B, and D services alongside Medi-Cal benefits, including specialized care coordination and potentially additional benefits not available in other plans.
- Integrated Care Teams: Members have access to a dedicated care team that helps manage their care across all health needs, offering a personalized approach to health care.
- Choice and Flexibility: Enrollment in D-SNP is voluntary and offers members a choice to simplify their health care by receiving both Medicare and Medi-Cal benefits under one plan.
Please be on the lookout for information from our Contracting Department to become part of our D-SNP provider network. We look forward to your response.
For more information, please visit:
https://www.dhcs.ca.gov/provgovpart/Pages/Dual-Eligible-Special-Needs-Plans-in-CA.aspx
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
