You may have heard of Medicare or Medicaid, but have you heard of a D-SNP? A D-SNP is a Dual Eligible Special Needs Plan. This plan is for those that qualify for both Medicare and Medicaid, therefore they are referred to as being ‘dual eligible’. A D-SNP is a type of Medicare Advantage plan. Medicare Advantage plans allow for bundling of coverage. MA plans are required to include Original Medicare Parts A and B, but most plans include additional benefits. D-SNP benefits cater to individuals who qualify for both Medicare and Medicaid.
What’s the difference between Medicare and Medicaid?
First, we need to take a look at what it means to qualify for Medicare. To qualify for Medicare you need to be over the age of 65 or have a qualifying disability that makes you eligible. Once you qualify for Medicare due to age or disability, you will have choices to make. Medicare is separated into different parts that cover various things. Part A generally covers inpatient hospital or skilled nursing facility stays. Some home health care and hospice are included within Part A. Part B is where you will find the coverage for outpatient visits, some preventive care, and durable medical equipment. Part D is optional prescription drug coverage.
Medicaid, on the other hand, is tied to income. Each of the 50 states has a form of Medicaid to offer insurance to low-income families, individuals, and children. It, like Medicare, is funded by the government but differs as it is run by individual states. Income levels to be eligible as well as medical coverage therefore will vary. Generally, you will most likely qualify if you make a predetermined amount less than the federal poverty level and are a caretaker of a child, are pregnant, disabled, or are elderly. You also must live in the state you apply for benefits in and are legally able to be there.
Enrolling in a Dual-Eligible Special Needs Plan
If you qualify for Medicare and Medicaid, you can enroll in a Dual-eligible Special Needs plan offered by private insurance companies. You can enroll in a D-SNP if you meet the criteria when you first qualify for Medicare (like becoming 65 years of age), during a Special Enrollment Period, or during Medicare’s Open Enrollment Period. OEP occurs between October 15 and December 7.
The D-SNP, which is a Medicare Advantage plan, combines Medicare, Medicaid, and Medicare Part D all in one. (Medicare Part D is the part of the plan that covers prescription medication). All Medicare Advantage plans vary in cost as they are through private insurance companies that have agreed to follow Medicare rules. However, if you currently already have Medicaid, Medicare, and Medicaid Part D at no cost, there will be no added cost to you to have a D-SNP.
We know that having a D-SNP means that we will have some coverage for hospital stays, medication, and visits to healthcare providers on an outpatient basis. But, a D-SNP offers something more. There may be coverage to see an ophthalmologist (eye doctor) for visual impairment or visit an audiologist for hearing loss. Often things such as transportation to and from appointments may be covered. There may even be some credits offered to purchase over-the-counter health products, fitness benefits, and dental coverage.
How do you enroll in a D-SNP?
You will need to show that you are Medicaid and Medicare eligible. If you know that you are eligible for Medicaid but haven’t gotten around to applying yet, you can do so by visiting Medicaid.gov. (Alternatively, you can locate a Medicaid office nearby and apply there).
Something to keep in mind when joining a D-SNP is that the plans often are HMOs (Health Maintenance Organizations). This means that you will most likely need to visit in-network providers. Nevertheless, there are some PPO (Preferred Provider Organization) options as well that may give you flexibility. In either case, you will need to select a primary care provider to be your main health professional.
If you qualify for Medicare and Medicaid, such as meeting requirements to be considered low-income, and being over the age of 65, or under 65 but eligible for Medicare due to being disabled, a D-SNP may be for you. Not only will you have available to you the health benefits you have become accustomed to such as coverage for hospital stays, home health care, and visits to your PCP, but you may have additional perks.