Dual Eligible Special Needs Plans (D-SNPs) help those with medical and financial needs. Its limited enrollment and great benefits are well worth investigating.
What is a Dual Eligible Special Needs Plan?
A Dual Eligible Special Needs Plan (D-SNP) is a Medicare Advantage plan. It is designed to provide special coverage for people who are enrolled in both Medicare and Medicaid. Rather than being on your own for Medicare’s out-of-pocket costs, a D-SNP helps take care of it for you if you’re in need.
Like all Advantage plans, it helps coordinate your care for lower costs. However, the nature of SNPs are much more targeted and focused on benefits—they help people in specific circumstances by providing specific coverage. For D-SNPs, that means cost coverage.
D-SNP Benefits
Because D-SNPs are Medicare Advantage plans at their core, they’re often structured the same way—with a network. D-SNPs also have the same benefits as the average Advantage plan, including everything Original Medicare has to offer. This also includes low or potentially $0 monthly premiums, Part D prescription drug coverage, limited vision and hearing benefits, and more.
D-SNPs will also cover a majority of your out-of-pocket costs for things like coinsurance and copayments, maybe even help with your monthly premiums.
You may have to pay copays or a deductible for any covered services but you can apply for help if needed. In addition to a $1,484 deductible for every benefit period, you’re responsible for additional costs.
D-SNP Eligibility and Enrollment
Nearly 12 million Americans are eligible for both Medicare and Medicaid. This means that 12 million people are eligible for a D-SNP. With both Medicare and Medicaid, you are also eligible for a D-SNP.
Each state has its own eligibility and coverage limits with Medicaid. Coverage also varies by state. No matter what, you’ll have to be eligible for Medicare by age or disability. You must be age 65 or older or have earned at least 24 months of Social Security disability insurance payments.
Medicaid eligibility is based on several factors, but mainly your Modified Adjusted Gross Income (MAGI). When you qualify, you will more than likely be automatically enrolled in a D-SNP that fits your needs, depending on the eligibility category you fit in. These categories are:
- Full Medicaid
- Qualified Medicare Beneficiary (QMB)
- QMB Plus
- Specified Low-Income Medicare Beneficiary (SLMB) without other    Medicaid
- SLMB Plus
- Qualifying Individual (QI)
- Qualified Disabled and Working Individual (QDWI).
Bottom line, a D-SNP is a great way for those with financial and medical needs to receive necessary benefits and cost coverage.
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