Dual Special Needs Plans

Dual Eligible Special Needs Plans (D-SNPs) are for individuals who are eligible for both Medicare and Medicaid. These plans are a special type of Medicare Advantage plan that offers healthcare coverage for dual-eligible people (people who qualify for both Medicare and Medicaid). 

D-SNP benefits vary state by state, but generally, these plans may include: 

  • $0 monthly premiums
  • Care coordination
  • Prescription drug coverage
  • Vision and hearing benefits
  • Over the counter quarterly benefits
  • Telehealth services
  • Transportation benefits
  • Gym memberships

Like many Medicare Advantage plans, these plans offer a bundled alternative to Original Medicare and include Medicare Part D (prescription drug coverage). To enroll in a D-SNP, beneficiaries must meet eligibility requirements for both Medicare and Medicaid and be enrolled in both.

Who is Eligible for D-SNPs?

Approximately 20% of the Medicare population, or 12 million Americans, are eligible for D-SNPs. To be eligible, you must qualify for both Medicare and Medicaid.

You are eligible for Medicare if you are 65 or older or have a qualifying disability, including ESRD. If your income level falls below your state’s threshold (generally, you need to make less than 100-200% of the federal poverty level), you are eligible for Medicaid.

How Do D-SNPs Work?

Medicare is always the first (primary) payer with D-SNPs. Once Medicare pays its share, Medicaid (referred to as the secondary payer) covers the remaining cost for Medicaid-covered expenses. Medicaid can help cover the costs of Medicare premiums, copayments, and deductibles. 

Medicaid also covers some expenses Original Medicare doesn’t cover, such as personal care assistance in your home, so getting both Medicare and Medicaid if you are dually eligible is a great option to save you money.

Not Sure If You Qualify?

Many people are dual-eligible and don’t even know it. Coastal Insurance Planning can help you figure out your best option for getting the best care and saving the most money. That’s what we do, after all—make it easy to get the coverage you need. Reach out today to learn more.