Monthly Stipend
Some plans include a monthly allowance to help purchase healthy groceries, over-the-counter medication, or home utilities.
Explore Medicare Dual Eligible Special Needs Plans (D-SNPs)
Dual Eligible Special Needs Plans (D-SNPs) are unique plans available to those eligible for both Medicare and Medicaid. D-SNPs provide an affordable Medicare option for those who qualify, with low or $0 monthly plan premiums. See if you qualify for a special needs Medicare plan.
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D-SNP benefits and features
A Dual Eligible Special Needs Plan acts as a kind of Medicare Advantage plan for people who qualify for both Medicare (either by age or special circumstance) and Medicaid (by income). As such, it provides all the benefits of Original Medicare (Parts A & B), including hospital and hospice care and medical insurance coverage. In addition, D-SNPs may provide benefits especially helpful for those enrolled in both Medicare and Medicaid, such as the following:
Prescription Drug Coverage
Many D-SNPs provide coverage for prescribed medications.
Dental Coverage
A D-SNP often includes coverage for preventative dental care, such as checkups and cleanings.
Transportation
A D-SNP may offer transportation costs for doctor visits and other essential travel, such as trips to the pharmacy.
Who is eligible for a D-SNP?
To qualify for a D-SNP, you must be eligible for Medicare by age or special circumstance, as well as entitled to state assistance through a Medicaid Plan.
Medicare eligibility:
- By age: If you are a United States citizen who has been living in the U.S. for the past 5 years and 65 years of age (or nearing your 65th birthday), you are eligible for Original Medicare (Parts A & B).
- By special circumstance: Some disabilities and conditions may qualify you for Medicare coverage before age 65:
- If you are disabled and have received Social Security benefits for at least 24 consecutive months
- If you suffer from kidney failure, also known as End-Stage Renal Disease (ESRD), and have had a kidney transplant or been on dialysis for 3 months
- If you have amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease)
Medicaid eligibility:
- Full Medicaid
- Qualified Medicare Beneficiary (QMB) without other Medicaid
- QMB Plus
- Specified Low-income Medicare Beneficiary without other Medicaid (SLMB)
- SLMB Plus
- Qualifying Individual (QI)
- Qualified Disabled and Working Individual (QDWI)
Find a D-SNP in your area today
Frequently asked questions about Dual Eligible Special Needs Plans
How do I enroll in a D-SNP?
To enroll in a Dual Eligible Special Needs Plan (D-SNP) you must be eligible for Medicare and entitled to state assistance through Medicaid. Medicare is generally available to those age 65 and older in the United States; you may also be qualified for Medicare before age 65 as the result of certain conditions:
- Some disabilities
- End-stage renal disease (permanent kidney failure requiring dialysis or transplant)
- Amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease)
To enroll in a Medicare D-SNP, use our plan comparison tool to find the plan that works best for you and enroll online during a qualifying enrollment period.
When do I enroll in a D-SNP?
If you are qualified for a Dual Eligible Special Needs Plan (D-SNP), enroll during the following qualified Medicare Enrollment Periods:
- Annual Enrollment Period – October 15-December 7 each year, available to anyone Medicare-eligible. During this period you can enroll in, drop, or switch Medicare D-SNPs.
- Special Enrollment Periods – Special Enrollment Periods for Dual Eligible Special Needs Plans differ from those associated with other plan changes. Since 2019, those who qualify for a D-SNP can use an SEP to change their D-SNP once every three months for the first nine months of the year:January 1-March 31April 1-June 30July 1-September 30
What are the costs to me for a D-SNP?
The out-of-pocket cost for a Dual Eligible Special Needs Plan (D-SNP) depends upon the state and the provider, but most plans feature $0 copays, deductibles, and premiums. If you are entitled to full Medicaid benefits from your state, all or most of your out-of-pocket costs should be covered by the plan.
What’s the difference between a D-SNP and a C-SNP?
While they are both Medicare special needs plans, D-SNPs and C-SNPs are for different groups of people. While D-SNPs are available to those who qualify for both Medicare and Medicaid, C-SNPs (Chronic Condition Special Needs Plans) are only for those who have either a single chronic condition or a related group of chronic conditions depending on the specific plan.
Do I need to pick a primary care physician (PCP) with a D-SNP?
You will need to choose a primary care physician (PCP) when enrolled in a D-SNP. If you have a preferred doctor, you can use our plan comparison tool to search by physician to find a plan that your preferred doctor accepts.
While you are required to have a PCP with your D-SNP, D-SNPs do not require that you get a referral from the PCP to see a specialist.
Can I choose a separate Part D plan with my Medicare Advantage D-SNP?
All Medicare special needs plans are required to provide prescription drug coverage (Part D) so you will not need a separate Part D plan if you enroll in a D-SNP.
Medicare resources
General Enrollment and Open Enrollment Periods
Learn about the two Medicare enrollment periods that run from January through March.
Medicare Annual Enrollment Period 101
When is the Medicare Annual Enrollment Period? Get answers to this and other AEP-related questions.
Medicare Enrollment Overview
Get fast facts about Medicare Enrollment, including when you qualify and when to enroll.