What Is a D-SNP? Understanding Dual Special Needs Plans

Navigating your health insurance options can sometimes feel like wandering through a maze. It can be even more confusing if you have complex healthcare needs due to disabilities or a limited income. But you do have options. A Dual Eligible Special Needs Plan (D-SNP) is one you might want to consider.

But just what is a D-SNP? And how is it different from other health insurance plans? Let’s take a closer look at what these plans are all about, who they can help and how they might work for you.

What is D-SNP?

A D-SNP is a Medicare Advantage Special Needs Plan that covers people with specific conditions or needs. The best way to think of a D-SNP is as a customized healthcare plan that’s made for people who qualify for both Medicare and Medicaid, who are referred to as ‘dual eligible.’

Medicare is designed to mainly cover people over the age of 65, while Medicaid coverage is based on income and other factors that vary by state. A Medicare Advantage D-SNP plan combines benefits from both programs to offer comprehensive coverage and enhanced benefits, usually at little to no cost.

The Purpose of Dual-Eligible Special Needs Plans

In addition to providing coverage for medical services and prescription drugs, D-SNPs offer benefits that go beyond traditional Medicare and Medicaid. One of the key differences is the care coordination services that are often included. These services help manage benefits offered by both health plans and make care more efficient. This is helpful for low-income people and those with complex health needs.

Eligibility & Enrollment Criteria for D-SNP

If you are eligible for both Medicare and Medicaid in your state, you may be eligible to enroll in a D-SNP.

To qualify for Medicaid, you must meet certain criteria related to age, income and disability. Premiums, copayments and deductibles may vary depending on your state and your Medicaid eligibility category. Click here to find out if you qualify for Medicaid in your state.

Many people who receive Medicaid benefits may not realize they may also qualify for Medicare. Generally, Medicare is designed for people 65 and over, but you can get Medicare earlier if you have certain disabilities. Click here for more information and to get started with Medicare.

Benefits and Services of D-SNP

Like all Medicare Advantage plans, a D-SNP must cover all the services offered by Medicare Parts A and B. These include things like doctor’s visits, hospital stays, outpatient care, medical supplies and preventative services.

But D-SNP plans offer benefits above and beyond the basics. These vary depending on the specific plan, but may include:

Dental, vision and hearing care
Cobertura de medicamentos recetados
Over-the-counter benefit
Transportation services
Fitness programs
Telehealth
24-7 Nurse line

Coordinated Care

With a Wellcare D-SNP plan, you can choose a primary care provider who gets to know you and can help coordinate care with your other providers. The goal is to streamline your healthcare experience and improve communication between your providers. It also helps to prevent duplicated or unnecessary services – making sure you’re getting personalized care in the most appropriate setting. The result is an enhanced patient experience and improved overall results.