Dual Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage plan designed for individuals who are eligible for both Medicare and Medicaid. D-SNPs are designed to provide coordinated care and comprehensive benefits to individuals with complex health care needs, including those who have both Medicare and Medicaid coverage.
What’s included in the D-SNP Coverage?
D-SNPs provide the same benefits as traditional Medicare Advantage plans, which include Part A (hospital insurance) and Part B (medical insurance).
However, they also offer additional benefits that may not be available in other Medicare Advantage plans, such as coverage for long-term care, prescription drugs, and transportation to medical appointments.
D-SNP Quality Standards
D-SNPs are required to meet certain quality standards set by the Centers for Medicare and Medicaid Services (CMS), which is the government agency responsible for administering the Medicare and Medicaid programs.
D-SNPs must also adhere to certain standards related to access to care, customer service, and the coordination of care among different health care providers.
How do you enroll in a D-SNP Plan?
To enroll in a D-SNP, individuals must be eligible for both Medicare and Medicaid and must live in the service area of the D-SNP they wish to join.
Individuals can enroll in a D-SNP during certain enrollment periods, such as during the annual open enrollment period or when they first become eligible for Medicare.
Overall, D-SNPs are designed to provide coordinated, comprehensive care and benefits to individuals with complex health care needs, including those who are eligible for both Medicare and Medicaid.
They are an option for individuals who are looking for a Medicare Advantage plan that meets their specific needs and provides additional benefits beyond those offered by traditional Medicare.
Dual Eligible Special Needs Plans (D-SNPs)
Dual Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual’s eligibility.
Medicaid Eligibility Categories
The Medicaid eligibility categories encompass all categories of Medicaid eligibility including:
- Full Medicaid (only);
- Qualified Medicare Beneficiary without other Medicaid (QMB Only);
- QMB Plus;
- Specified Low-Income Medicare Beneficiary without other Medicaid (SLMB Only);
- SLMB Plus;
- Qualifying Individual (QI); and
- Qualified Disabled and Working Individual (QDWI).
States may vary in determining their eligibility categories; therefore, there may be state-specific differences in the eligibility levels in comparison to those listed here. For specific information regarding Medicaid eligibility categories, refer to the Medicaid website.
NOTE: CMS no longer categorizes D-SNPs by subtype (see the below link to the December 7, 2015, HPMS memo “Discontinuation of Dual Eligible Special Needs Plans Sub-type Categories”).
D-SNPs With or Without Medicare Zero-Dollar Cost Sharing
At the time of plan creation, each D-SNP must identify whether or not if offers Medicare zero-dollar cost sharing. In HPMS, D-SNPs will have the option of one of the following two indicators:
- Medicare Zero-Dollar Cost Sharing Plan, or
- Medicare Non-Zero Dollar Cost Sharing Plan.
These two indicators will be used in multiple areas within HPMS and are essential to the proper display of benefits in Medicare Plan Finder.
