D-SNP
Dual Eligible Special Needs Plans
A Dual Eligible Special Needs Plan, or D-SNP, is a type of Medicare Advantage plan for people who have both Medicare and Medicaid. It is designed to coordinate the two programs in a single plan.
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Both programs in one plan
Medicare and Medicaid benefits are coordinated through a single plan rather than managed independently.
Prescription drug coverage is usually included
Most D-SNPs include Part D, so a separate prescription drug plan is generally not needed.
Care coordination
Many D-SNPs offer care coordination to help members navigate providers, services, and benefits across both programs.
Additional benefits may be offered
Plans may include benefits beyond Original Medicare. What is offered varies by plan and by area.
How a D-SNP works
D-SNPs are a form of Special Needs Plan, which is a Medicare Advantage plan limited to people in a particular situation. In this case, that situation is being eligible for both Medicare and Medicaid.
Because the plan works with both programs, it can coordinate benefits that would otherwise be managed separately. Most D-SNPs also include Part D prescription drug coverage.
What affects your costs
- Your level of Medicaid eligibility
- Medicaid eligibility comes in categories, and which one applies to you affects what you pay for Medicare costs such as premiums, deductibles, and coinsurance.
- The plan you choose
- Costs and benefits vary between D-SNPs, and which plans are available depends on where you live.
- State Medicaid rules
- Medicaid is administered by each state, so what it covers and who qualifies differs depending on where you live.
- Talking it through
- Because eligibility categories drive so much of the cost, this is worth reviewing with a licensed insurance agent rather than estimating.
What you may pay
- Your Part B premium
- Depending on your Medicaid eligibility category, your state may pay some or all of your Part B premium.
- Plan costs
- What you pay for covered services depends on the plan and on your level of Medicaid eligibility.
- Prescription costs
- People with both Medicare and Medicaid generally qualify for Extra Help with Part D costs.
Who can enroll
- You are entitled to Medicare Part A and enrolled in Part B.
- You are eligible for Medicaid in your state.
- You live in the plan’s service area.
- People who have both Medicare and Medicaid may have more frequent opportunities to enrol in or change plans than other people do.
When you can enroll
Initial Enrollment Period
7 months around your 65th birthday
Begins 3 months before the month you turn 65, includes that month, and ends 3 months after. This is when most people first enroll, and enrolling early in the window generally means coverage starts sooner.
Annual Enrollment Period
15 October to 7 December
Each autumn you can join, switch, or drop a Medicare Advantage or Part D plan. Changes made during this window generally take effect on 1 January.
Medicare Advantage Open Enrollment
1 January to 31 March
If you are already in a Medicare Advantage plan you can switch to a different one, or return to Original Medicare, once during this window. It is not available to people who are in Original Medicare on 1 January.
General Enrollment Period
1 January to 31 March
For people who did not sign up for Part B when first eligible and do not qualify for a Special Enrollment Period. A late enrollment penalty may apply.
Medigap Open Enrollment Period
6 months from Part B enrollment at 65
Begins the month you are both 65 or older and enrolled in Part B. During it you can buy any Medigap policy sold in your state regardless of your health. It does not repeat.
Special Enrollment Period
When your circumstances change
Certain life events, such as moving or losing other coverage, can open a window to make a change outside the usual periods. How long it lasts depends on the event.
Frequently asked questions
Other coverage options
Medicare Advantage
Medicare Advantage, sometimes called Part C, is offered by private insurance companies that contract with Medicare. These plans bundle your Part A and Part B coverage into a single plan, and most include prescription drug coverage as well.
Medicare Part DPrescription Drug Plans
Medicare Part D helps cover the cost of prescription drugs. It is offered by private insurance companies approved by Medicare, either as a standalone plan or built into a Medicare Advantage plan.