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Learn how D-SNPs support clients who have both Medicare and Medicaid. Understand eligibility, benefits, and why these plans matter for healthcare access.
If you have clients who are enrolled in both Medicare and Medicaid, they may be eligible for a Dual Eligible Special Needs Plan (D-SNP). A D-SNP is a specialized type of Medicare Advantage plan that offers integrated benefits to individuals who require significant support. Like all Medicare Advantage plans, D-SNPs are offered by private insurance companies under contract with Medicare, ensuring that the plan’s benefits meet federal guidelines. Understanding how these plans work can help you better meet your clients’ needs.
You may already be familiar with general Medicare Advantage plans, which primarily coordinate Medicare-covered services. However, D-SNPs go a step further by coordinating both Medicare and Medicaid benefits under one plan. By streamlining coverage, D-SNPs aim to remove common barriers to care for individuals with complex healthcare needs.
Who Qualifies for a D-SNP?
To qualify for a D-SNP, an individual must be a U.S. citizen or a lawful permanent resident, be eligible for Original Medicare, and meet the income and, in some cases, asset limits set by their state’s Medicaid program. D-SNPs are only available in certain areas, so a person must also live in a service area where a plan operates. Some plans may have additional eligibility criteria depending on the type of Medicaid benefits a person receives. Full Medicaid beneficiaries and those participating in Medicare Savings Programs may have different options based on their state’s offerings.
What Benefits Do D-SNPs Offer?
D-SNPs cover all the services offered by Original Medicare, including hospital and medical insurance, as well as prescription drug coverage under Medicare Part D. In addition, they often provide extra services that Original Medicare and Medicaid do not typically offer. These additional benefits may include dental care, vision services, hearing aids, meal delivery programs, and allowances for healthy food and over-the-counter medications. Many D-SNPs also offer gym memberships and wellness programs.
A key feature of D-SNPs is access to care coordinators. These professionals help members schedule appointments, arrange transportation, and find healthcare providers. Some plans even offer a personal care team to further tailor healthcare to the individual’s specific needs. This added layer of support makes D-SNPs especially valuable for individuals managing multiple health conditions.
How Much Do D-SNPs Cost?
Costs under a D-SNP are usually very low. Medicare pays its share first, and Medicaid generally covers the remainder, minimizing or eliminating out-of-pocket expenses. However, the exact costs can vary depending on the individual’s Medicaid eligibility category and the specific plan they choose.
Key Enrollment Periods for D-SNPs
To enroll in a D-SNP, a person must first be enrolled in Original Medicare. There are several key enrollment periods to be aware of. The Initial Enrollment Period starts three months before the month of a person’s 65th birthday and lasts for seven months. The Medicare Advantage Open Enrollment Period runs each year from January 1 to March 31, and allows individuals enrolled in a Medicare Advantage plan to switch plans or return to Original Medicare. The Fall Annual Enrollment Period, from October 15 to December 7, offers another opportunity to make changes.
In addition to these regular periods, individuals with both Medicare and Medicaid usually qualify for a Special Enrollment Period (SEP) that lets them change plans once per month — offering important flexibility, such as when their Medicaid eligibility changes or they move to a new service area.
Get Legal Support
Navigating programs like D-SNPs can be complex. If you operate in a state where we have licensed attorneys, consider scheduling a consultation to discuss how healthcare law and insurance options affect your practice and your clients. View the list of our licensed states.
This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.
