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Dual Special needs

Dual Special Needs Plans

Dual-Eligible Special Needs Plan (D-SNP) is a Special Needs Plan under the Medicare Advantage Plan that limits the enrollment of eligible Medicare Beneficiaries who meet specific eligibility criteria. It covers individuals who qualify for both Medicare and Medicaid coverage. Medicare provides health benefits for people over the age of 65. Persons younger than 65 may also qualify for other reasons, including a disability or a chronic condition. Medicaid is, however, targeted at people with low income and provides health benefits for them.

A D-SNP will offer coverage for Original Medicare (Medicare Part A and Medicare Part B) and prescription drugs (Medicare Part D). A Dual-Eligible Special Needs Plan is commonly confused with a Medicare Advantage Medicare-Medicaid Plan (MMP). While MMPs only serve full benefit dual (Medicare/Medicaid) eligible beneficiaries and some additional limitations may apply (such as state-specific requirements), a D-SNP does not.


D-SNPs include all Medicaid eligibility categories, including full Medicaid, Specified Low-income Medicare beneficiary, Qualifying Individual, and Qualified Medicare Beneficiary. With D-SNPs, you get more benefits that are not usually covered with Original Medicare. D-SNPs are a combination of doctor, hospital and prescription coverage, and over-the-counter (OTC) products, all in one plan. The eligibility category may vary depending on the state.

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If you are eligible for D-SNP, you can enroll during either the regular Medicare Advantage enrollment period or the Special Enrollment Period (SEP). Enrollment in the Special Needs Plan can only remain active as long as beneficiaries meet the plan’s eligibility criteria.

Suppose your situation changes and you no longer meet the eligibility requirements for the Special Needs Plan. In that case, you will qualify for a Special Enrollment Period to switch to a different Medicare Advantage Plan or return to Original Medicare.

Thriving Seniors is here to help you understand your Medicare options so you can make the best choice. Reach out today for more information.