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What Is a Medicare Advantage D-SNP?

D-SNP stands for Dual-Eligible Special Needs Plan. This plan is a type of Part C plan that is tailored for those who are eligible for both Medicare and Medicaid. Through this plan, beneficiaries with certain healthcare needs and high out-of-pocket costs get the healthcare coverage they need. If you are 65, have limited income, or have a chronic health condition that requires constant healthcare coverage, you may qualify for both federal and state health coverage. 

With a Dual-Eligible Special Needs plan, you can get extended Medicare coverage through Medicare Advantage and Medicaid. Medicare is a federal health insurance program, while Medicare Advantage is a part of Medicare that is sold by private insurers. Medicaid is a state health program that was created for low-income individuals, families, pregnant women, etc. 

Dual-Eligible Special Needs plans are the most complex Part C Special Needs Plan due to the coverage and eligibility requirements. However, you can get more comprehensive benefits through this plan than through other SNPs if you have certain healthcare needs. To purchase a D-SNP, you will be required to prove that you are eligible.

Eligibility and Enrollment

Before you can enroll in any Part C Special Needs plan, you must be enrolled in Medicare Parts A and B. To enroll in a D-SNP, you must be able to prove that you’re eligible for Medicare and Medicaid. People who receive disability benefits from Social Security or from the Railroad Retirement Board also qualify for Medicare. 

The eligibility requirements for Medicaid may vary depending on the state. To enroll in Medicaid, you must fall under one of the general eligibility categories such as: 

  • Qualified Medicare Beneficiary (QMB)
  • QMB Plus
  • Specified Low-Income Medicare Beneficiary (SLMB) 
  • SLMB Plus
  • Qualifying Individual (QI)
  • Qualified Disabled and Working Individual (QWDI) 
  • Full Medicaid

What Do They Cover?

Under D-SNPs, you will get coverage for the same healthcare services as other Medicare Advantage plans. D-SNPs cover hospital costs, outpatient healthcare services, hospice care, skilled nursing facility care, fitness and gym memberships, transportation, dental, vision, etc. SNPs, including D-SNPs, are also required to cover all prescriptions that are part of the Medicare prescription drug list. 

If you have a D-SNP, both Medicare and Medicaid will cover your healthcare costs. Medicare will cover the approved services, while Medicaid will cover the remaining healthcare costs. It’s important to know that the eligibility requirements and coverage may vary depending on the state. To confirm your eligibility, contact your local or nearest Medicaid office.

Work with an Agent Who Understands Medicare

Many people have trouble determining which Medicare Advantage plan is best for them. However, if you need help with making this decision, we at Generations Insurance are always here to help. If you have any concerns or questions, give us a call today!