All About Medicare Dual Eligible Special Needs Plans

Depending on your circumstances, you may not only qualify for Medicare — you may be eligible for a Medicare Special Needs Plan (SNP). These are types of Medicare Advantage plans that cater toward beneficiaries with specific medical or financial needs. You may be familiar with Chronic Condition SNPs (C-SNPs) or Institutional SNPs (I-SNPs), but the plans we’d like to focus on right now are Dual Eligible SNPs (D-SNPs).

What are Dual Eligible Special Needs Plans?

A D-SNP is a Medicare Advantage plan that utilizes both Medicare and Medicaid to offer affordable, benefit-rich coverage for qualifying people. They can be HMOs or PPOs. Since D-SNPs are Medicare Advantage plans, they must offer everything that traditional Medicare covers at a minimum, but the benefits don’t stop there. The plan can organize a coordinated care team to assist with the different aspects of your care, like health care provider visits or crafting a care plan with your doctor that fits your individual needs. This team often includes professionals like a care coordinator, a nurse care manager, a social worker, and a member advocate. Together, they make sure your needs are heard and met.

D-SNP benefits may vary based on your state, since Medicaid medical benefits are defined at the state level, as well as the insurance carrier. That said, many D-SNPs tend to offer the following benefits:

  • $0 monthly premiums
  • Over-the-counter quarterly benefits
  • Prescription drug coverage
  • Dental, vision, and hearing benefits
  • Transportation benefits
  • Gym memberships
  • Telehealth services

While these benefits are often standard in this type of plan, you can sometimes find plans with a greater degree of coverage. D-SNPs may also cost differently depending on the plan. The good news is that, while you may still have costs, they will likely be lower than those with other Medicare Advantage plans since you qualified for additional assistance through Medicaid. We suggest exploring your options if you qualify for a D-SNP to see the differences for yourself.

Who Qualifies for D-SNPs?

Since Medicare D-SNPs rely on coverage from both Medicare and Medicaid, you need to be eligible to enroll in both. For Medicare, you must be 65 or older or meet one of the other qualifying circumstances, like receiving 25 months of Social Security Disability Insurance (SSDI) or having ALS or End-Stage Renal Disease. Eligibility for Medicaid varies based on state, which can make figuring out your own eligibility a bit tougher, but it’s still worth exploring.

D-SNP eligibility isn’t as straightforward as, if you’re eligible for both Medicare and Medicaid, you can enroll in a D-SNP. There are actually different categories, or dual eligible standards, that depend on your Medicaid coverage and a few other factors. For example, depending on your circumstances, you may qualify for a Plus plan, which uses the eligibility category’s coverage along with full Medicaid benefits.

2022 Dual Eligible Standards

Enrolling in a D-SNP

If you’re interested in a D-SNP, enrolling is pretty simple. First and foremost, you can enroll in a D-SNP anytime you would enroll in any other Medicare Part C plan. The Annual Enrollment Period (AEP) and Medicare Advantage Open Enrollment Period (MA OEP) are both options when it comes to switching to the plans. You also have a Special Enrollment Period (SEP) when you become dual eligible, or eligible for both Medicare and Medicaid. Similarly, dual eligible beneficiaries are able to enroll, unenroll, or switch D-SNPs once per each of the first three calendar quarters. This gives you plenty of opportunities to find a plan that fits your unique circumstances.

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If you qualify for both Medicare and Medicaid, a D-SNP is worth exploring at the very least. With the added benefits they can offer, you have the potential for a plan that not only has quality coverage, but also a team whose goal is to make sure the plan is meeting your needs.