Dual Eligible Special Needs Plans (D-SNP) combine Medicare and Medicaid coverage for qualifying individuals—learn what they are, who qualifies, and how to enroll.
A Dual Eligible Special Needs Plan, known as a Medicare Advantage D-SNP, is a form of health coverage that may be open to people with special needs. Knowing exactly what a D-SNP is, who qualifies for one, and how the application works matters a great deal. Depending on someone's situation, a D-SNP might be the best fit, so it deserves consideration alongside the other health insurance choices out there when making an informed decision. If this leaves you confused or overwhelmed, we're here to help.
D-SNPs are offered to individuals who qualify for both Medicare and Medicaid at the same time. Each state plays a role in deciding which D-SNPs its residents can access and what those plans cover. Typically, these plans bundle hospital, medical, and prescription drug coverage together.
Beyond that, D-SNPs may come with no monthly premiums, care coordination, vision and hearing benefits, quarterly over-the-counter allowances, transportation, telehealth services, and gym memberships. The usual D-SNP types are grouped as follows:
The primary requirement for a D-SNP is qualifying for both Medicare and Medicaid, which a person might do based on age, income, or disability. Anyone who thinks they qualify can apply to have their eligibility and enrollment evaluated.
You can sign up for a D-SNP during the set enrollment periods, and which one applies depends on your circumstances. Usually this occurs during open enrollment or, for those who qualify, a special enrollment period. Back in 2019, the Center for Medicare and Medicaid Services (CMS), the agency in charge of Medicare and Medicaid, established special enrollment rules for prospective D-SNP applicants and members. Under these rules, anyone eligible for the Low-Income Subsidy or Dual Special Enrollment Period may switch plans once each quarter throughout the first nine months of the year, covering January – March, April – June, and July – September. Someone who believes they qualify for a Special Needs Plan must also obtain extra approval from CMS for MA-PD, which is a contract.
To gain approval for an SNP, applicants need to file through the Health Plan Management System (HPMS) so that CMS can assess their status. After being cleared to take part in SNPs, people generally enroll in a plan via the Online Enrollment Center (OEC), where providers can receive and review the submitted application.
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