Dual Special Needs Plans

Dual Eligible Special Needs Plans, or Medicare Advantage D-SNP, is a type of health insurance that could be available to those with special needs. It’s important to understand what a D-SNP is, the eligibility for these types of plans, and how to apply. D-SNP could be considered the most suitable option depending on a person’s circumstances, so this option should be considered —along with other available health insurance options—for people to make an informed decision when choosing their health insurance. Feeling lost? Overwhelmed? Let us help.

What Is D-SNP?

D-SNPs are available to those that are dual-eligible for both Medicare and Medicaid. An individual’s state is involved with determining which D-SNPs are offered to its residents and what is covered under the plans. Most commonly, these plans provide hospital, health, and prescription drug coverage. 

In addition, D-SNPs may involve no monthly premiums, care coordination, vision and hearing benefits, over-the-counter quarterly benefits, transportation benefits, telehealth services, and gym memberships. The common types of D-SNP are categorized as:

  • All Dual
  • Full Benefit
  • Medicare Zero Cost Sharing
  • Dual Eligible Subset
  • Dual Eligible Subset Medicare Zero Cost Sharing.

The main eligibility requirement involved in D-SNPs is that a person must qualify for Medicare and Medicaid, which could otherwise be due to their age, income, or disability. If someone believes they are eligible, they can apply to have their eligibility and enrollment reviewed.

How to Apply

Enrollment in D-SNPs can be done during the designated enrollment periods, which can depend on the situation. Most commonly, this falls within open enrollment or a special enrollment period for those that qualify. As of 2019, the Center for Medicare and Medicaid Services (CMS), which oversees Medicare and Medicaid, enacted special enrollment conditions for potential D-SNPs participants and enrollees. Under this, people that are eligible for Low-Income Subsidy or Dual Special Enrollment Period are allowed to make plan changes once per quarter for the first nine months of the year, which include the periods of January – March, April – June, and July – September. If an individual believes they qualify for a Special Needs Plan, they also have to get additional approval from the CMS for MA-PD, which is a contract.

To be approved for an SNP, participants should submit the application through the Health Plan Management System (HPMS) so CMS can review their status. Once approved to participate in SNPs, individuals most commonly apply for a plan through the Online Enrollment Center (OEC), which allows providers to receive and review the application from there.

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How We Help People Like You

We are Carolina Senior Benefits. Our agents specialize in various areas related to Medicare and Medicaid. Located in the northern Charlotte area, we work with the best insurance companies to help make it easy for you to compare and choose the right plan at the right price.

Our website has plenty of pages and articles that can help educate you on Medicare. If you’d like immediate assistance, you can always call us at (704) 765-4689.