Dual Eligible Special Needs Plans (D-SNP)
Dual Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage Special Needs Plan designed for individuals who are eligible for both Medicare and Medicaid. These plans coordinate benefits between the two programs according to federal and state guidelines.
Who Is Eligible?
Eligibility for a D-SNP requires that an individual qualify for Medicare and also meet their state’s Medicaid eligibility requirements. Medicaid eligibility categories and benefit levels are determined by state-specific rules. Ongoing eligibility must be maintained for continued enrollment in a D-SNP.
How D-SNP Plans Work
D-SNPs integrate Medicare-covered services with Medicaid-covered services to provide coordinated care. These plans may include enhanced care management, provider coordination, and benefit alignment intended to simplify access to covered services.
Benefit Coordination
Because Medicaid benefits vary by state and eligibility category, D-SNP coverage details may differ depending on individual circumstances. Plans must follow both Medicare regulations and applicable state Medicaid agreements.
Enrollment Considerations
Enrollment in a D-SNP is limited to individuals who meet defined dual-eligibility criteria. If Medicaid eligibility status changes, continued enrollment in the plan may be affected. Enrollment opportunities generally follow established Medicare enrollment periods and applicable Special Enrollment Periods.
Disclaimer: This information is provided for educational purposes only and is based on publicly available guidance from the Centers for Medicare & Medicaid Services (CMS). It has not been reviewed or endorsed by Medicare, CMS, or any federal agency. This content does not constitute plan-specific advice. For individual coverage questions, please consult a licensed insurance professional.