Dual Special Needs Plans (D-SNPs) are a type of Medicare Advantage Plan designed specifically for people who have dual eligibility and are enrolled in both Medicare and Medicaid. These plans can help by coordinating the delivery of Medicare and Medicaid benefits to ensure you have the care, savings, and resources that you need.
Medicare Advantage Plans, including D-SNPs, are offered by private insurance companies. However, these companies and Medicare plans are carefully monitored by the Centers for Medicare & Medicaid Services (CMS) to ensure that they meet the Medicare standards.
Eligibility for Medicare Advantage Dual Special Needs Plans (D-SNPs)
Individuals who are enrolled in Medicare (Parts A and B) and in their state Medicaid program are said to have dual eligibility in Medicare and Medicaid and are eligible for Dual Special Needs Plans. States sometimes give their Medicaid program a different name, like MediCal (California) or TennCare (Tennessee), so it’s good to double check if you’re in a Medicaid program.
You may be eligible for Medicare if you’re turning 65 or older. Also, younger people who receive Social Security disability benefits are eligible for Medicare.
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What do Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) include?
Dual Eligible Special Needs Plans (D-SNPs) include everything provided under Original Medicare (Parts A and B), which is hospital and doctor coverage. They may also provide extra benefits, often at no extra cost.
Medicare Advantage Dual Special Needs Plans may include benefits like:
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Dental benefits, such as routine exams, fillings, and x-rays
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Vision benefits, such as eye exams
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Hearing benefits, such as exams and hearing aids
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Telehealth doctor visits via your smartphone, computer, or tablet
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Fitness benefits, such as SilverSneakers® or RenewActive
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Prescription drug coverage (Part D) (always included in D-SNPs)
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Meal delivery
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Transportation to and from doctor visits
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A Flex Allowance or over-the-counter (OTC) allowance you can use to buy hundreds of health-related products, such as vitamins, toothpaste, bandages, allergy medicine, and much more
Medicare Advantage Dual Eligible Special Needs Plans typically have affordable monthly premiums and may have $0 deductibles and copays.
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You can enroll in a Dual Special Needs Plan through an insurance carrier that offers these plans or through a licensed insurance agent who may be able to help you compare plans from multiple carriers. Plan comparison and enrollment is also available online.
When Can You Enroll in a D-SNP?
If you have dual eligibility in Medicare and Medicaid, you can enroll in a D-SNP once per quarter every year:
January – March
April – June
July – September
October 15 – December 7
– the Medicare Annual Enrollment Period (AEP)
Your plan coverage will begin on the first of the following month, with the exception of AEP at the end of the year, when new coverage begins on January 1.
If you have recently become dual eligible either by joining Medicare or Medicaid, you may be able to enroll in a Dual Special Needs Plan right now.
Are you eligible for both Medicare and Medicaid?
Ask About Dual Special Needs Plans In Your Area.
Additional Resources
If you’re eligible for a Dual Special Needs Plan through dual eligibility in Medicare and Medicaid, you may be qualified for additional assistance through a Medicare Savings Program or Extra Help (also called Low-Income Subsidy). You might have been added to these programs when you were added to Medicaid, but it’s worth checking to make sure you’re not missing out on any savings.
Enrollment Eligibility
Annual Enrollment Period (AEP)
Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?
Initial Enrollment Period (IEP)
Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.
Special Enrollment Period (SEP)
You may be eligible if you experience a qualifying life event such as moving to a new zip code, losing employer coverage, or change in Medicaid status.
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