Dual Special Needs Plans (D-SNPs)
If you have both Medicare and Medicaid, you may qualify for a Dual Eligible Special Needs Plan. We can help you review D-SNPs available in your area and understand how the plans work with your Medicare and Medicaid coverage.
D-SNPs are a type of Medicare Advantage plan designed specifically for people who are eligible for both programs and may provide additional coordination of Medicare and Medicaid benefits.
Eligibility for a Dual Eligible Special Needs Plan depends on Medicare and Medicaid eligibility requirements and plan availability in your service area.
Could You Qualify for a Dual Special Needs Plan?
D-SNPs are designed for people who qualify for both Medicare and Medicaid. Your eligibility, location, and level of Medicaid assistance can affect which plans may be available to you.
Have Medicare
D-SNP enrollment generally requires you to have Medicare Part A and Part B and continue meeting Medicare eligibility requirements.
Qualify for Medicaid
You must also qualify for Medicaid assistance. Your Medicaid eligibility category can affect the D-SNP options available to you.
Live in the Service Area
You must live within the service area of the D-SNP you want to join. Available plans can differ depending on your location.
Meet the Plan's Requirements
Individual D-SNPs can have specific eligibility requirements, so qualifying for Medicare and Medicaid doesn't necessarily mean every D-SNP in your area is available to you.
Not Sure What Medicaid Coverage You Have?
You don't need to sort through the eligibility rules on your own. A licensed Vista Insurance Partners agent can help review your situation and determine which D-SNPs from the insurance companies we represent may be available to you. D-SNPs are a type of Medicare Advantage Plan, so plan choices and eligibility requirements can vary by area.
Have Medicare and Medicaid? Let's see what D-SNP options may be available.
Check Your OptionsWhat Can a Dual Special Needs Plan Include?
D-SNPs combine Medicare Advantage coverage with features designed for people who also receive Medicaid. Depending on the plan and your eligibility, coverage may include additional benefits and services beyond Original Medicare.
Coordinating Your Medicare and Medicaid Coverage
One of the important features of a D-SNP can be greater coordination between your Medicare benefits, Medicaid assistance, healthcare providers, and other services. The specific level of coordination depends on the plan and the Medicaid program where you live.
Prescription Drug Coverage
D-SNPs generally include Medicare Part D prescription drug coverage. Drug lists, pharmacy networks, and medication costs can differ between plans. Learn more about Medicare prescription drug coverage .
Dental, Vision & Hearing
Some D-SNPs offer supplemental dental, vision, or hearing benefits. Covered services, provider requirements, allowances, and benefit limits depend on the individual plan.
Over-the-Counter Benefits
Some plans provide an allowance for eligible over-the-counter health and wellness products. The amount, eligible items, and how the benefit can be used vary by plan.
Transportation Benefits
Certain D-SNPs may provide transportation for eligible healthcare-related trips. Plans can have limits on the number of trips, approved destinations, or how transportation is arranged.
Food & Healthy Benefits
Some plans may offer qualifying members benefits that can be used for certain healthy foods or other eligible items. Availability, qualification requirements, benefit amounts, and eligible purchases vary by plan.
Additional Support
Depending on the plan, additional services or supplemental benefits may be available to help members manage their healthcare needs. The specific benefits offered can differ substantially from one D-SNP to another.
Benefits Aren't the Same With Every D-SNP
A plan offering a particular benefit doesn't mean every member receives the same amount or qualifies to use it in the same way. Benefits, allowances, eligibility requirements, provider networks, costs, and service areas vary by plan. That's why it's important to review the actual plan details rather than choosing a D-SNP based on one advertised benefit.
See which D-SNP benefits and plan options may be available where you live.
Compare D-SNP OptionsYour Medicaid Eligibility Matters
Having Medicare and Medicaid doesn't necessarily mean everyone has the same coverage. The Medicaid assistance you receive can affect your D-SNP eligibility and how your Medicare and Medicaid benefits work together.
Medicaid Coverage Can Be Different
Medicaid is administered by each state within federal requirements, and people can qualify for different types or levels of assistance.
Two people may both have Medicare and Medicaid while receiving different levels of help with Medicare premiums, deductibles, copays, or other healthcare costs.
These differences can affect which D-SNP options you may qualify for and how your Medicare and Medicaid coverage work together.
Why Does Your Medicaid Status Matter?
Don't Know Your Medicaid Level?
You don't need to know your Medicaid category or the terminology before speaking with us. A licensed Vista Insurance Partners agent can help review your information when determining which D-SNP options from the companies we represent may be available to you.
Have Medicare and Medicaid? We can help you understand your D-SNP options.
Review My D-SNP OptionsWhat to Check Before Choosing a D-SNP
D-SNPs can look similar at first, but the details can make a meaningful difference. Before choosing a plan, look beyond the extra benefits and make sure the coverage fits your healthcare needs.
Your Doctors & Hospitals
Check whether your doctors, specialists, hospitals, and other healthcare providers participate in the plan's network. Provider networks can differ between Medicare Advantage Plans, including D-SNPs.
Your Prescriptions
Review whether your medications are covered, which pharmacies are in the plan's network, and what requirements or costs may apply. Learn more about Medicare prescription drug coverage.
Your Healthcare Costs
Don't evaluate a plan by its monthly premium alone. Review the plan's copays, deductibles, cost-sharing, and other potential out-of-pocket costs, along with how your Medicaid assistance may affect what you pay.
Supplemental Benefits
Compare dental, vision, hearing, over-the-counter, transportation, food or healthy-benefit allowances, and other supplemental benefits that may be available. Benefits, eligibility, limits, and availability vary by plan.
How Your Medicare & Medicaid Work Together
Your Medicaid eligibility can affect which D-SNPs are available to you and how your healthcare costs and benefits are coordinated. Make sure you're comparing plans based on your specific eligibility, not someone else's coverage.
The Biggest Extra Benefit Isn't Automatically the Best Plan
An attractive allowance can get your attention, but it shouldn't be the only reason you choose a D-SNP. Your doctors, prescriptions, healthcare costs, Medicaid eligibility, and overall coverage can matter much more. Compare the entire plan before making a decision.
We can help you compare the D-SNP options available in your area.
Compare D-SNP PlansDual Special Needs Plan FAQs
Get answers to common questions about Dual Eligible Special Needs Plans, eligibility, benefits, and choosing coverage.
A Dual Eligible Special Needs Plan, often called a D-SNP, is a type of Medicare Advantage Plan designed for people who qualify for both Medicare and Medicaid. These plans coordinate Medicare coverage with Medicaid assistance and may include additional benefits depending on the plan.
D-SNPs are designed for people who have Medicare and also qualify for Medicaid. Eligibility can depend on your Medicare status, Medicaid eligibility, where you live, and the requirements of the specific plan.
No. Benefits can vary significantly by insurance company, plan, location, and eligibility. Depending on the plan, benefits may include dental, vision, hearing, transportation, over-the-counter allowances, or other supplemental benefits. Always review the specific plan details before enrolling.
It depends on the plan. D-SNPs can have provider networks, so your doctors, specialists, and preferred hospitals should be checked before you enroll. A provider participating with one plan does not necessarily mean they participate with every D-SNP.
D-SNPs generally include Medicare prescription drug coverage, but covered medications, pharmacies, and plan requirements can differ. Review your medications before choosing a plan. You can also learn more about Medicare prescription drug coverage.
People who are eligible for both Medicare and Medicaid may have opportunities to change coverage outside the Annual Enrollment Period, but the timing and rules depend on your circumstances and current Medicare enrollment rules. Check your eligibility before making a change so you know when a new plan would begin.
A change in Medicaid eligibility can affect your D-SNP eligibility, healthcare costs, or coverage options. If your Medicaid status changes, review your Medicare coverage rather than assuming your current benefits will remain the same.
Compare more than the advertised extra benefits. Check your doctors and hospitals, prescriptions, pharmacy options, potential healthcare costs, supplemental benefits, and how the plan works with your Medicaid eligibility. Vista Insurance Partners can help you compare D-SNP options from the insurance companies we represent.
Still Have Questions About D-SNPs?
Talk with a licensed agent and get help comparing your options.
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