What is a Dual Eligible Special Needs Plan (D-SNP)?

By: Devoted Health Team
January 17, 2025

We all know that signing up for Medicare can be confusing — and, if you’re also eligible for Medicaid, that’s 2 healthcare programs to figure out! It may sound overwhelming, but this might actually be to your advantage. Why? Because you could get more benefits and have less out of pocket costs than with each program individually.

So, you ask, isn’t there a way to just put it all together in one plan? The answer is yes! A Dual Special Needs plan (D-SNP) does that and more. A D-SNP is a Medicare Advantage plan that's designed specifically for people who are dual eligible, meaning people who qualify for both Medicare and Medicaid.

A D-SNP combines the benefits of Medicare and Medicaid with low or no monthly premium payments. You might not even have out-of-pocket costs. D-SNPs also include prescription coverage and extra benefits like dental coverage. In addition, you could get help with care coordination, streamlining communication between Medicare and Medicaid services for a better healthcare experience.

What’s the difference between a D-SNP and a C-SNP?

The 2 types of SNPs you’ll probably hear about most are Dual Eligible Special Needs Plans (D-SNPs) and Chronic Condition Special Needs Plans (C-SNPs). Both are Medicare Advantage plans, and both can be either HMO or PPO plans.

But here’s how they’re different:

D-SNPs are designed for people who have both Medicare and Medicaid. In other words, you can enroll in or switch to a D-SNP and get coverage that combines Medicare and Medicaid services. It’s actually one of the most popular SNPs. D-SNPs may also include extra benefits such as dental care coverage, vision benefits, and a grocery allowance — along with support from a dedicated care team that can help you navigate and make the most of your benefits.

C-SNPs are designed for people with specific chronic or disabling conditions. If you have a long-term health condition such as diabetes, heart disease, or an autoimmune disorder, a C-SNP might be a good choice. These plans are especially set up to manage specific health needs.

How do I know if I’m eligible for a D-SNP?

To be eligible for a D-SNP, you must:

• Live within the service area of a D-SNP
• Be eligible for both Original Medicare Parts A and B and Medicaid in your state
• Have dual eligibility (which means you qualify for full state Medicaid benefits)

Note: Depending on your state, you may qualify for partial dual eligibility (which means you qualify for a more restricted set of Medicare benefits). In some cases, this might also qualify you for a D-SNP (which also depends on your state).

Haven’t signed up for Medicare yet?

Get started by checking to see if you meet the eligibility requirements.

Haven’t signed up for Medicaid yet?

Eligibility for Medicaid is based on your income and differs according to the state you live in.

Keep in mind:

D-SNPs and benefits can vary according to:

• The Medicare Advantage company you choose
• Your Medicaid eligibility category
• Where you live (even within a state, D-SNPs can vary by county)

What benefits do D-SNPS offer?

By combining Medicare and Medicaid under one plan, D-SNPs can help you get the benefits included with both programs, plus extras — and you could potentially lower your out-of-pocket costs. Most D-SNPs have low or no monthly premiums, copayments, or deductibles, which can make them more affordable.

If you’re managing multiple health conditions, a D-SNP might be an especially good fit. D-SNPs give you access to teams that can help you coordinate and keep track of appointments, routine labs, prescriptions, and any other care you might need.

With a D-SNP, you could also get extra benefits, including:

• A monthly allowance for certain household expenses*
• Dental coverage with allowances for comprehensive care
• Eye exams and with allowances or credits for eyewear
• Hearing exams and coverage for hearing devices
• Non-emergency medical transportation
• Meal delivery services
• Wellness programs, gym memberships, or fitness classes

What out-of-pocket costs can I expect with a D-SNP?

Medicare Advantage plans like D-SNPs are offered by private insurance companies — which means costs (if any) can vary. In most cases, if you have a D-SNP, most of your healthcare costs will likely be covered.

When you’re on a D-SNP, the key to lowering healthcare costs is to stay in-network. You can lower your out-of-pocket costs by visiting doctors, pharmacies, and hospitals that are in your plan’s network (versus going outside of the network).

You may be able to find a list of providers under a D-SNP plan by using a plan’s provider directory or by calling your health insurance company.

Out-of-pocket costs can include:

• Copays
• Coinsurance
• Deductibles for doctor visits, hospitalization, and prescription coverage

When can I enroll in a D-SNP?

Starting in 2025, if you’re dual-eligible, you can make changes to your plan during the Annual Enrollment Period (AEP). AEP runs from October 15 to December 7, and any changes take effect on January 1 of the following year.

There are other enrollment times, depending on your situation or certain life circumstances:

If you want to join a Medicare Advantage plan or switch plans

If you need to make a plan change, there is an Open Enrollment Period (OEP), which runs from January 1 to March 31. During this period, you can join or switch to a different Medicare Advantage plan.

If you’ve had a major life change

Did your Extra Help status change? Did you lose or become eligible for Medicaid? Or maybe you’ve moved to a new address — or lost a job that provided your insurance? Besides AEP and OEP, there is a Special Enrollment Period (SEP) for people who have gone through (or are going through) certain life events.

Note: It’s important to stay up to date when it comes to Medicare enrollment rules and dates. If you have questions about when to sign up (or full dual eligibility vs. partial dual eligibility), be sure to call your plan provider or talk to your insurance broker.

What should I keep in mind when signing up for a D-SNP?

When deciding on a D-SNP:

• Compare plan options, and pay close attention to benefits.
• Understand details around premiums, copays, and out-of-pocket costs.
• Find out if the plan offers the help you need with personalized care management.
• Make sure the plan covers your prescribed medications.

Have questions or need additional information? You can always call a plan provider or insurance company. Alternatively, a Medicare broker could be a great resource. Medicare brokers know the market, and they’re experts in matching people to the right plans. Best of all, the service is free!

How Devoted Health can help

We have licensed representatives available to help you with any questions about Devoted Health Medicare Advantage plans. Call us at 1-800-483-8066 (TTY 711) for personalized assistance.

You can also learn more about your Medicare options in this free Medicare Comparison Guide.

*The Food & Home Card is a special supplemental benefit available only to chronically ill members with eligible chronic health conditions, like diabetes, high blood pressure, high cholesterol, heart problems, and stroke. Other conditions may be eligible. All applicable eligibility requirements must be met before the benefit is provided. Not all members qualify. The Food & Home Card is not available on all plans. For D-SNP plans, you must receive "Extra Help" to qualify for the Food & Home Card.

Related articles

Snips or SNPs?: Your guide to Medicare Special Needs Plans
Your Medicare options
7 tips for managing your medications