February 7th 2024
By Ari Parker
Learn everything you need to know about Dual Eligible Special Needs Plans (D-SNP) in this comprehensive guide. Discover how they work and who qualifies.
By Ari Parker
Dual Eligible Special Needs Plans (D-SNPs) serve almost 3.8 million people in the US. These Medicare Advantage plans help meet the needs of people who qualify for both Medicare and Medicaid. D-SNPs provide additional healthcare benefits, reduced out-of-pocket costs, and financial assistance for day-to-day expenses.
In this article, we’ll explain how D-SNPs work, who qualifies for them, and how to get the most out of their benefits.
Dual Eligible Special Needs Plans are a type of Medicare Advantage plan for people who have or are eligible for both Medicare and Medicaid.
D-SNP benefits can help you spend less on healthcare or get access to extra benefits to help you maintain your health and wellness.
You need to be “dually eligible” to qualify for a D-SNP. This means that you meet the requirements to receive benefits from both Medicare and Medicaid.
While Medicare provides health insurance for people aged 65 and older or with certain disabilities, Medicaid offers assistance to people with low incomes and resources. The programs are different, but work together in one plan to provide the best coverage for those who are eligible. Take a look at the requirements for both programs below.
You qualify for Medicare if:
You’re 65 or older
You have certain disabilities
You have End-Stage Renal Disease (ESRD)
You are diagnosed with Amyotrophic Lateral Sclerosis (ALS)
The eligibility requirements for Medicaid vary across states, but there are common factors that states look for. Check your state’s requirements for a better idea of your eligibility. You’ll generally qualify for Medicaid if:
You have a low income
You have a disability (conditions can vary by state)
You receive assistance from other federal programs like Supplemental Security Income (SSI)
People who are eligible for Medicare and Medicaid often have complex healthcare needs and financial circumstances. Dual Eligible Special Needs Plans help these people get the care they need.
There are three types of D-SNPs:
Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP),
Highly Integrated Dual Eligible Special Needs Plan (HIDE SNP)
D-SNP Affiliated with Managed Long-Term Services and Supports (MLTSS)
Each of these D-SNPs have a different level of care and relationship between Medicare and Medicaid.
Though DC and most states offer D-SNPs, you won’t find them in a few states. New Hampshire, Vermont, Illinois, Wyoming, North Dakota, South Dakota, and Alaska don’t have D-SNPs available. You’ll also see that some counties within a state don’t offer D-SNPs. Availability can also change each year.
There are many benefits of a D-SNP that are important to know if you are eligible. D-SNPs provide additional support for healthcare costs, healthcare management, day-to-day finances, and greater drug coverage. Plans vary, but you can generally expect these benefits:
Lower costs (you’ll have lower costs for premiums, deductibles, or coinsurance)
Dental, vision, and hearing services
Fitness and wellness programs
Additional money to pay for food and groceries, rent and utilities, and over-the-counter (OTC) items. D-SNPs typically provide a flex card to pay for these benefits.
D-SNPs are just one kind of Special Needs Plan (SNP). SNPs broadly help people who have unique healthcare situations. Aside from D-SNPs, there are two other types of Special Needs Plans with different eligibility requirements:
C-SNPs are specific policies that help provide extra coverage for people with certain chronic conditions like diabetes, cardiovascular disease, or chronic heart failure. Benefits of a C-SNP include care management for these conditions and access to specialists. Most plans reduce, or eliminate, the amount you need to pay for these services too.
I-SNPs are for people who live in nursing homes or other long-term care facilities. Benefits of these plans include nursing care services, rehabilitative services like physical therapy, and wider coverage for medications.
Your health and wellness is a priority. If you need a D-SNP, you have a lot on your mind. Understanding your plan and how to use it should be the least of your worries.
Unfortunately, D-SNPs don’t always make it easy for you to take advantage of their full benefits. We’ve commonly seen D-SNP holders let benefits, like over-the-counter credits, go unused.
Whether you want help using your benefits or finding a better D-SNP plan to fit your needs, we’re here to help! Call us at 855-900-2427 or pick a time to chat to get more out Medicare.
