A Medicare Dual Eligible Special Needs Plan (D-SNP) is a type of Medicare Advantage Plan that is only available to a specific subset of Medicare enrollees. More broadly, Special Needs Plans (SNPs) provide coverage to people with specific diseases or circumstances. Dual Eligible Special Needs Plans are set up to help ensure that people experiencing financial hardship have access to the medical care they need.
A Medicare D-SNP is available to people who have both Original Medicare and Medicaid. You must maintain your eligibility for both of these programs to stay enrolled in a D-SNP. Not all carriers or regions offer Dual Eligible Special Needs Plans, so check with an expert if you think you may be eligible for enrollment.
Losing your Medicaid eligibility means you will be disenrolled from the D-SNP. After your eligibility lapses, you have a grace period before your coverage ends to reestablish that you meet Medicaid’s requirements. Medicare requires that this grace period lasts at least a month, though some plans may have a larger window.
If you are not able to re-enroll in Medicaid, you aren’t out of options! You enter a Special Enrollment Period (SEP) when you receive notice that you are no longer Medicaid eligible. The SEP runs through your D-SNP’s grace period, and for 2 months after your coverage ends if you are unable to re-enroll. During this time, you can shop for another plan to make sure you are never without coverage.
Medicare Part B covers doctor visits and outpatient care, including:
Doctor visits, including when you are in the hospital
Diabetes screenings, education, and certain supplies
An annual wellness visit and preventive services, like flu shots
Mental health care
Clinical laboratory services, like blood and urine tests
Durable medical equipment for use at home, like wheelchairs and walkers
X-rays, MRIs, CT scans, EKGs and some other diagnostic tests
Ambulatory surgery center services
Some health programs, like smoking cessation and obesity counseling
Ambulance and emergency room services
Physical therapy, occupational therapy and speech-language pathology services
Dual Eligible Special Needs Plans cover the same care as Medicare Advantage Plans. This includes hospital insurance, medical insurance, and prescription drug coverage. D-SNPs also provide additional benefits at no cost to you like dental, vision, and hearing care. Since these plans are designed for people with limited financial resources, most healthcare costs are covered between the Original Medicare and Medicaid components.
Individuals enrolled in D-SNPs also receive benefits to offset the cost of everyday necessities. Some plans offer up to $165 a month in over-the-counter medicine and healthy food allowances. This benefit is designed to help enrollees buy essential health and grocery items. In addition, there are D-SNPs that include flex spending cards for dental, vision, and hearing costs not specifically covered by the plan.
Another benefit provided by D-SNPs is a care coordinator. These skilled professionals work to help you access all of the resources available to you. It can be tough to navigate the benefits you receive through Medicare and Medicaid, not to mention other programs within your community. The care coordinator’s goal is to keep you informed and help you make the best use of these services. Taking advantage of every healthcare benefit at your disposal is a great way to keep you in the best health possible!
Not everyone needs a Dual Eligible Special Needs Plan, but this kind of coverage is incredibly valuable for those who need it. If you have Medicaid and will soon be eligible for Medicare coverage, we’d love to hear from you! Senior Insurance Advisors will always work hard to make sure you understand your options and empower you to make the best decisions for your Medicare coverage.
All Rights Reserved | Senior Insurance Advisors | Privacy
All Rights Reserved | Senior Insurance Advisors | Privacy Policy
We are licensed and represent plans and carriers in AZ, CO, IA, KS, MN, MO, NE, SC, SD, TX, and WA. The following disclaimer is for Lancaster county in Nebraska, where we reside.
We do not offer every plan available in your area. Currently we represent 8 organizations which offer 53 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all your options.Not affiliated with or endorsed by the government or federal Medicare program. Participating sales agencies represent Medicare Advantage [HMO, PPO, PFFS, and PDP] organizations that are contracted with Medicare. Enrollment depends on the plan’s contract renewal. By providing the information above, I grant permission for a licensed insurance agent to contact me regarding my Medicare options including Medicare Supplement, Medicare Advantage, Prescription Drug plans.