- A Medicare Dual Eligible Special Needs Plan (D-SNP) is a Medicare Advantage plan designed to provide special coverage for people who are enrolled in both Medicare and Medicaid.
- These plans help people with the highest needs cover out-of-pocket costs they may otherwise be responsible for under traditional Medicare programs.
If you are age 65 and over or have certain health conditions and have limited finances to pay for your care, you may fall into a select group that’s qualified for both federal and state public health insurance programs. In fact, nearly 12 million Americans are entitled to both Medicare and Medicaid coverage based on their age and health conditions. If you’re one of them, you may qualify for a D-SNP.
Read on to learn what a D-SNP is and whether you may be eligible for one.
A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage (Part C) plan that provides extended Medicare coverage. These private plans help coordinate care and benefits between Medicare, which is a federal program, and Medicaid, which is a state program.
D-SNPs are the most complex of the different SNPs in terms of both coverage and eligibility requirements. However, they also offer the most comprehensive benefits because those who qualify have the highest need.
What does a Dual Eligible Special Needs Plan cover?
D-SNPs are Medicare Advantage plans, so they cover all the same services that many Medicare Advantage plans offer. These include:
- $0 monthly premiums
- care coordination services
- Medicare Part D prescription drug coverage
- some over-the-counter supplies and medications
- transportation to medical appointments
- vision and hearing benefits
- fitness and gym memberships
With most Medicare Advantage plans, you pay a portion of your plan cost out of pocket. With a D-SNP, Medicare and Medicaid pay most or all of the costs.
Medicare pays for a share of your medical costs first, then Medicaid pays any costs that may be left over. Medicaid is known as the second payer for costs that are not covered or only partially covered by Medicare.
While federal law sets Medicaid income standards, each state has its own Medicaid eligibility and coverage limits. Plan coverage varies by state, but there are some plans that include all Medicare and Medicaid benefits.
To be considered for any of the SNPs, you first must be enrolled in Medicare parts A and B (original Medicare), which cover hospitalization and other medical services.
There are a variety of D-SNPs available. Some are Health Maintenance Organizations (HMO) programs, and some may be Preferred Provider Organizations (PPO) programs. The plans differ based on the insurance company you select and the area where you live. Each program may have different costs.
You can call 800-MEDICARE (800-633-4227) for more information or to ask questions about D-SNPs and other Medicare benefits.
Qualifying for Medicare
You are eligible for Medicare starting at age 65. You have 3 months before and after the month you turn 65 years old to enroll for initial Medicare coverage.
You are also eligible for Medicare, regardless of age, if you have a qualifying condition or disability, such as end stage renal disease (ESRD) or amyotrophic lateral sclerosis, or if you have been on Social Security Disability Insurance for 24 months or more.
If you are eligible, you may enroll in a D-SNP during an appropriate Medicare enrollment period, as long as D-SNPs are offered in your area.
Qualifying for Medicaid
Medicaid eligibility is based on several factors, including your income, health conditions, and whether you qualify for Supplemental Security Income. To find out if you’re entitled to Medicaid coverage in your state and to receive confirmation of your eligibility, contact your state’s Medicaid office.
You may, under certain circumstances, be automatically enrolled for Medicare parts A and B when you turn 65 years old. But you will not be automatically enrolled in a D-SNP because it is a type of Medicare Advantage plan.
You may purchase Medicare Advantage plans, including D-SNPs, during Medicare-approved enrollment periods, which include:
- Medicare Advantage from January 1 to March 31
- open enrollment from October 15 to December 7
- special enrollment period if you have a change in your living situation
To enroll in any Medicare Advantage plan, including D-SNPs, follow these steps:
- Choose a plan in your area (see Medicare’s plan finder tool for plans in your ZIP code).
- To enroll online or request a paper form to enroll by mail, visit the insurance company’s website for the plan you have chosen.
- Call 800-MEDICARE (800-633-4227) if you need assistance.
documents you will need to enroll in a D-SNP
- your Medicare card
- the specific date you started Medicare parts A and/or B coverage
- proof of Medicaid coverage (your Medicaid card or an official letter)
Usually with an SNP, you would pay a share similar to what you would pay under any Medicare Advantage plan. Premiums, copayments, coinsurances, and deductibles may vary depending on the plan you choose.
With a D-SNP, your costs are lower because your health, disability, or financial situation has qualified you for additional support from the federal and state governments.
- If you have extensive health needs or disabilities and your income is limited, you may qualify for both federal and state support.
- Dual Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage plan that covers your hospitalization, outpatient medical care, and prescriptions; the costs of the plan are covered by federal and state funds.
- If you qualify for both Medicare and your state’s Medicaid program, you may be entitled to low or no-cost healthcare under a D-SNP.