Dual Special Needs Plans

What are D-SNPs?

D-SNPs are a type of Medicare Advantage Plan geared toward those with a limited income, with severe and chronic conditions such as HIV/AIDS, chronic heart failure, and End-Stage Renal Disease. The “Dual” part of the term is based on the fact that qualifying for this plan means that you qualify for both Medicare and Medicaid.

Determining eligibility

Two factors determine eligibility: qualifying for Medicare and Medicaid together. To go deeper, Medicare eligibility means that you are either at least 65 years old, or you have been receiving Social Security or Disability benefits for 24 months.

Medicaid eligibility is based on income, and you can obtain it if you earn below the Modified Adjusted Gross Income (MAGI). The qualifying MAGI varies from state to state.

What you can do with this plan

D-SNPs give you all the benefits of Original Medicare, which includes coverage for hospital visits and outpatient treatments. But they are also required to offer benefits beyond this. All D-SNPs provide prescription drug coverage. All D-SNPs provide benefits beyond what can be attained through Original Medicare, such as coverage for dental and hearing treatments. These programs also revolve around healthcare needs specific to your condition.


Coverage is limited to your plan’s network. Also, like other types of Medicare Advantage Plans such as HMOs, you must choose a primary care doctor. In most cases, you will need a referral from that doctor before you can see a specialist.

When to enroll

Enrolling in a D-SNP doesn’t have to be a difficult process as long as you are aware of the Medicare Enrollment Periods:

  • Initial Enrollment Period: The Initial Enrollment Period is a seven-month period that starts your Medicare eligibility. It begins three months before your 65th birthday, and ends three months after. 
  • Annual Enrollment Period: AEP begins on October 15 and ends December 7 of every year. During this period, you have the option to make changes to your Medicare coverage, such as switching from Original Medicare to Medicare Advantage. If you’re currently enrolled in Medicare Advantage, you also have the option to switch to a different Medicare Advantage Plan.
  • Special Enrollment Period: The SEP can be triggered in several ways, but is ultimately unique to the individual’s situation. It is best to speak with a Medicare agent to determine if you do qualify for a SEP, but one of the most common reasons beneficiaries do qualify for this period is because they moved out of their plan’s service area and need a new plan. If you do qualify for this period, you have the option to make changes to your Medicare Advantage Plan, or you switch back to Original Medicare.

For further information about Medicare Advantage and D-SNPs, call me today at (407) 924-8109.