Dual Special Needs Plans

Dual Special Needs Plans (D-SNPs) are a type of Medicare Advantage that is available to those with great financial needs who qualify for both Medicaid and Medicare.

What is an Advantage D-SNP?

D-SNPs are a part of Medicare Advantage. Unlike other Advantage plans, however, D-SNPs have specific eligibility requirements for enrollment beyond Original Medicare eligibility.

There are five types of D-SNPs, each with varying degrees of coverage:

  • All-Dual
  • Full Benefit
  • Medicare Zero Cost Sharing
  • Dual-Eligible Subset
  • Dual-Eligible Subset Medicare Zero Cost Sharing

Eligibility for a D-SNP

When you enroll in a D-SNP, you will fall into one of those categories and receive coverage. How, then, are you eligible? Generally speaking, D-SNP eligibility requires you to be enrolled in both Medicare and Medicaid.

From there, your dual-eligibility fits into one of seven dual-eligible categories under Medicaid. States may have specific eligibility requirements or limits, so keep in mind the differences your state may have. These dual-eligible categories include:

  • Qualified Medicare Beneficiary (QMB) Only
  • QMB (QMB) Plus
  • Specified Low-Income Medicare Beneficiary without other Medicaid (SLMB) Only
  • Specified Low-Income Medicare Beneficiary with other Medicaid (SLMB) Plus
  • Qualifying Individual (QI)
  • Qualified Disabled and Working Individual (QDWI)
  • Other Full Benefit Dual Eligible (FBDE)

Coverage with a D-SNP

Because eligibility categories and types of D-SNPs are so specific, benefits and coverage will be catered to your specific needs. While specific benefits will vary based on this, your provider, plan, and location, common benefits include:

  • Credits to buy health products
  • Transportation assistance
  • Care coordination via a personal care coordinator
  • Personal emergency response system (PERS)
  • Tele-health options such as virtual medical visits with your doctor
  • Worldwide emergency coverage

Frequently Asked Questions About D-SNPs

When can you enroll in a D-SNP? 

You can enroll in a D-SNP as soon as you are eligible for both Medicare and Medicaid. Oftentimes, enrollment will happen automatically. If not, you may contact your Medicare provider or Social Security office and alert them of your need to enroll.

Where can you use your D-SNP benefits? 

When you’re enrolled in a D-SNP, you can receive extra, necessary benefits for your day-to-day life apart from medical benefits as well, if you qualify. You can use these additional benefits at discount and dollar stores, thrift stores, food banks and pantries, community centers, and more.

How can you enroll in and qualify for Medicaid? 

You must have Medicare and Medicaid for a D-SNP. Medicaid eligibility is based on your income. You can enroll simply by contacting your state’s Medicaid office. Then, you will simply have to provide them with various proofs of income.

Get the Most Out of Your D-SNP

If you qualify for a D-SNP, you not only have to manage and understand your Medicare coverage but your Medicaid coverage as well. Having someone like Iowa Illinois Senior Solutions to support you can help make sure you fully understand and take advantage of your coverage. If you have any questions, give us a call at 563-579-6116, or email us at jon@iailsenior.com.

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