A Medicare Dual Eligible Special Needs Plan (D-SNP) is a special Medicare Advantage plan covering enrollees of both Medicare and Medicaid. It helps with high out-of-pocket costs not covered by traditional Medicare programs.

If you are 65 and over or have certain health conditions and limited finances to pay for your care, you may be eligible for federal and state public health insurance programs.

In fact, nearly 12 million Americans are eligible for and enrolled in 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.

D-SNPs are Medicare Advantage plans that cover all the services many Medicare Advantage plans offer. These include:

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.

Generally, your premium will depend on the specific plan, but some may have $0 monthly premiums

What is the difference between SNP and DSNP?

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 SNPs in terms of coverage and eligibility requirements. However, they also offer the most comprehensive benefits because those who qualify have the highest needs.

Usually, with an SNP, you would pay a share similar to that under any Medicare Advantage plan. Premiums, copayments, coinsurances, and deductibles may vary depending on your chosen plan.

However, 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.

Other than their benefit in terms of cost, according to an analysis by Justice in Aging, D-SNPs are closely monitored and regulated by the federal government. These plans must follow an approved care model, work with Medicaid benefits, and be monitored by an advisory committee.

States also have a say in how these plans operate, which means there there different types of plans depending on how integrated they are with Medicaid in each state. The more integrated they are, the more comprehensive and coordinated your healthcare services might be.

Like other Medicare Advantage plans, D-SNPs may cover additional services beyond what’s covered by Original Medicare, such as dental care. The Centers for Medicare & Medicaid Services (CMS) require that if Medicare or Medicaid could potentially cover a service, the plan must review it using criteria from both programs.

This means that if your plan doesn’t cover something and you appeal it, the plan will have to conduct a comprehensive review and may reconsider your request.

While federal law sets Medicaid income standards, each state has its own Medicaid eligibility and coverage limits. Plan coverage varies by state, but some include all Medicare and Medicaid benefits.

To be considered for any of the SNPs, you must first be enrolled in Medicare Parts A and B (Original Medicare), which cover hospitalization and other medical services.

There are various 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 can enroll for initial Medicare coverage for three months before and after the month you turn 65.

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 income, health conditions, and whether one qualifies for Supplemental Security Income.

Contact your state’s Medicaid office to find out if you’re entitled to Medicaid coverage in your state and to receive confirmation of your eligibility.

When you turn 65, you may be automatically enrolled for Medicare Parts A and B under certain circumstances. However, you won’t 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:

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)

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; federal and state funds cover the plan’s costs.

If you qualify for Medicare and your state’s Medicaid program, you may be entitled to low—or no-cost healthcare under a D-SNP.