What is a Dual Special Needs Plan (HMO D-SNP)?

Dual Special Needs Plans are for people who have both Medicare and Medicaid (called "dual eligible"). A Dual Special Needs Plan (D-SNP) is a unique Medicare Advantage plan that combines your Medicare Part A and Part B benefits, and your Medicare Part D prescription drug coverage. You'll get extra support to help coordinate the plan with your Medicaid plan. In addition, a dual health plan provides extra benefits not provided by either Medicare or Medicaid.

Exclusive Enrollment Under One Plan

As an L.A. Care Medicare Plus member, you will be enrolled with L.A. Care for both your Medicare and Medi-Cal Programs. By aligning both your Medicare and Medi-Cal enrollment with L.A. Care, we will be able to better coordinate your care. When you enroll with L.A. Care Medicare Plus, your Medi-Cal plan will automatically be changed to L.A. Care if you are not a member of L.A. Care for Medi-Cal already.

Enrollment in L.A. Care's Exclusively Aligned D-SNP

L.A. Care currently has members who have both Medicare and Medicaid that are enrolled in L.A. Care Medicare Plus, Dual Eligible Special Needs Plan (HMO D-SNP). You are eligible for membership in our plan as long as all of the following are true:

  • You have both Medicare Part A (Hospital) and Medicare Part B (Medical)
  • You live in Los Angeles County
  • You are age 21 and older at the time of enrollment (You can be eligible for Medicare before 65 if you are living with a qualifying disability)
  • You receive full Medicaid (Medi-Cal) benefits (Medicaid is a joint federal and state government program that helps with medical costs for certain people with limited incomes and resources).  
  • To be eligible for our plan you must be eligible for both Medicare and Medicaid (dual eligible).

It is important to learn about the difference in the L.A. Care Medicare Plus (HMO D-SNP) vs Medicare Fee for Service, how much premiums and deductibles are, the costs associated with hospital stays or doctor visits and whether there is a limit on the out-of pocket amount for the year.

What are Original Medicare costs?

It is important to note that with Original Medicare (Part A and Part B), which is your hospital and medical insurance, there is no limit to the amount you pay out-of-pocket. The only way around this is through supplemental coverage which is designed to fill in the gaps.

What is the L.A. Care Medicare Plus costs?

As a L.A. Care Medicare Plus member, your cost for the following items is $0:

  • Plan premium
  • Plan deductible
  • Plan benefits
  • Prescription medications (RX)
  • Transportation
  • Dental
  • Vision
What does Original Medicare cover?

Original Medicare (Part A and Part B) combined will cover medical supplies, professionals, and various healthcare settings.

What does L.A. Care Medicare Plus (HMO D-SNP) cover?

L.A. Care Medicare Plus covers everything Original Medicare does plus the addition of added benefits like hearing, dental, vision and transportation through Medicaid (Medi-Cal).

Does Original Medicare cover prescription drugs?

No, you will need to enroll into a Prescription Drug Plan (Part D).

Does L.A. Care Medicare Plus (HMO D-SNP) cover prescription drugs?

L.A. Care Medicare Plus does provide Part D (Prescription Drug) benefits at $0 cost to you.

Will I be able to choose any doctor with Original Medicare?

With Original Medicare, you have the ability to go to any doctor that accepts Medicare.

Will I be able to choose any doctor with L.A. Care Medicare Plus (HMO D-SNP)?

L.A. Care Medicare Plus does require that members choose a doctor within our network of providers. L.A. Care Medicare Plus is proud to offer a wide network of doctors, specialists and hospitals.