Healthcare Educators


What Happens If You Are No Longer Eligible for Medicaid and a Dual-Eligible Special Needs Plan?

by | Apr 25, 2023

With the end of the COVID-19 Public Health Emergency, you may find yourself among the millions of people who are no longer eligible for Medicaid. If this is the case, you will no longer qualify for your Medicare Dual-Eligible Special Needs Plan (D-SNP) and will need to take steps to enroll in a new Medicare plan to avoid a lapse in coverage.

Understand Your Options

If you disagree with the decision to disenroll you from Medicaid, you can file an appeal by writing to the Texas Health and Human Services Commission, PO Box 149027, Austin, TX 78714-9027, by calling 211 and choosing option 2, or by visiting a local office.

If you were disenrolled because you did not finish all the steps to renew your Medicaid benefits on time or you missed the appeal deadline but you believe you still qualify, you need to reapply.

If you lose full Medicaid coverage, you may still qualify as partial dual eligible. This condition is for individuals who qualify for Medicare but don’t receive full Medicaid benefits. If you lose your full Medicaid benefits but still participate in a Medicare Savings Program, you may qualify for a partial dual plan. However, these plans are not available in all areas.

What Happens Next?

If you lose Medicaid coverage, you will receive written notice from your D-SNP explaining you will be disenrolled if you do not regain eligibility within your plan’s grace period. The grace period is always at least one month, but it can be up to six months, depending on the plan. You can still receive care and services during the grace period, but you will be responsible for any out-of-pocket costs Medicaid would have paid. If you remain ineligible, your D-SNP must send a second notice informing you of when your coverage will be terminated.

If your coverage is terminated, there is a Special Enrollment Period (SEP) for you to enroll in a new Medicare Advantage Plan or switch back to Original Medicare with a Prescription Drug Plan. The SEP starts the day you are notified that your coverage is ending and runs for 6 months after your Medicaid coverage ends. Coverage begins the month after you sign up or the date your Medicaid coverage ends – whichever you choose.

Other Cost Saving Programs

Even though you are no longer eligible for Medicaid, you may still qualify for programs that help you with out-of-pocket costs. In addition to Medicare Savings Programs, you may qualify for help paying for your prescriptions through Low Income Subsidy/Extra Help and the Texas Rx Assistance Programs.

How a Medicare Agent Can Help

Losing your D-SNP eligibility and finding a new Medicare plan can be unsettling, but you don’t have to navigate these changes alone. Our team of local, licensed Medicare agents at Medicare Educators represent many health insurers in the area. We offer personalized guidance to help you compare plans and find the best plan to meet your needs. We will take an in-depth look at several factors:

  • Affordability of plans based on your budget, premiums, and out-of-pocket costs.
  • How a plan will cover your prescriptions.
  • Whether your preferred pharmacies, doctors, and hospitals are in the network.
  • How a plan will cover any chronic health conditions or illnesses.
  • Any added benefits you may want, such as dental, hearing, vision, and wellness programs.

We can offer help with enrollment and will make sure you meet deadlines to avoid a lapse in coverage. We never charge any fees for our service. Contact Medicare Educators today.