Dual Eligible Special Needs Plans (D-SNP)
Special plans for those eligible for both Medicare and Medicaid.
Special plans for those eligible for both Medicare and Medicaid.
A Special Needs Plan (SNP) provides benefits and services to people with specific severe and chronic diseases, certain health care needs, or who also have Medicaid. An SNP provides benefits and services to people with specific conditions, certain health care needs, or who also have Medicaid. SNPs include care coordination services and tailor their benefits, provider choices, and list of covered drugs (formularies) to best meet the specific needs of the groups they serve.
You can join an SNP if you meet these requirements: You have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). You live in the plan's service area. You meet the eligibility requirements for one of the 3 types of SNPs. D-SNPs are for those who are dually eligible for Medicare and Medicaid. People who have both Medicare and full Medicaid coverage are “dually eligible.”
For example, if you have a severe condition, like cancer or congestive heart failure, and you need a hospital stay, an SNP may cover extra days in the hospital. D-SNPs also contract with your state Medicaid program to help coordinate coverage between Medicare and Medicaid managed care plans. All SNPs must provide Medicare drug coverage (Part D). SNPs might also cover extra services tailored to the special groups they serve.
You can only stay enrolled in an SNP if you continue to meet the special conditions of the plan. There are chances to make changes using Special Enrollment Periods, such as if you lose eligibility or move. Join or switch to a plan that can help coordinate coverage between Medicare and Medicaid (called an integrated Dual Eligible Special Needs Plan (D-SNP)) if one’s available in your area.
If you choose to join a Medicare Advantage Plan, there are special plans for dual eligibles that make it easier for you to get the services you need, include Medicare drug coverage (Part D), and may also cost less. Medicare pays first when you’re a dual eligible and you get Medicare-covered services. Medicaid offers benefits not normally covered by Medicare, like nursing home care and personal care services.