Medicare is the federal program offering healthcare coverage for U.S. citizens 65 and over. Medicaid comprises state-run healthcare assistance for low-income families and individuals. If you are eligible for both Medicare and Medicaid, you can sign up for a Dual: Eligible Special Needs Plan (D-SNP) with a low or $0 monthly premium.
Dual Eligible Special Needs Plans (D-SNPs) are private-sector insurance policies available to those who qualify for Medicare (by age or special circumstance) and Medicaid (by income). Similarly to Medicare Advantage plans, D-SNPs provide the same coverage as Original Medicare (Parts A & B), plus additional benefits that differ by plan, location, and provider.
D-SNPs have numerous benefits to those eligible. First, D-SNPs are often available at a low premium cost, with many plans as low as $0 monthly. Second, D-SNPs improve care quality and efficiency by arranging care on the policyholder’s behalf. Third, D-SNPs offer additional health care and wellness benefits that help fill in the gaps in Original Medicare coverage.
D-SNPs may cover the out-of-pocket cost for one or more of the following:
If you are eligible, browse plans during a qualifying enrollment period to find a D-SNP that matches your specific need.
U.S. citizens may qualify for Medicare by age or by special qualifying conditions.
To qualify for Medicaid, you must meet your state’s income requirements. The following Medicaid eligibility categories that qualify you for a D-SNP:
Since 2017, our more than 300 U.S.-based and licensed agents have helped more than 100,000 people find the right healthcare coverage for them. Working with some of the biggest Medicare insurance brands like UnitedHealthcare®, WellCare, Humana, and more, we connect you with the plan that works for you. If you are eligible for a Dual Eligible Special Needs Plan and in a qualifying enrollment period, click or tap the button below to browse available plans in your area.
How do I enroll in a D-SNP?
If you meet the Medicare and Medicaid eligibility requirements for enrollment and are in a qualifying enrollment period (see question and answer below), enroll in private sector D-SNP coverage by using our plan comparison tool online, or by calling to speak to an agent.
When do I enroll in a D-SNP?
If you are already on Medicare and eligible for Medicaid, you can sign up during the Annual Enrollment Period for Medicare, which occurs every year from October 15 through December 7. When you enroll in a policy during this time, it goes into effect on January 1 of the following year.
If you are new to Medicare and eligible for Medicaid, you can enroll in a D-SNP during your initial enrollment period (IEP). Special Enrollment Periods to enroll in a D-SNP may be available to those who are on Medicare and experience a change in their Medicaid status.
What are the costs to me for a D-SNP?
Out-of-pocket and premium costs for Dual Eligible Special Needs plans are low. Most plans offer $0 monthly premiums, and low or $0 copays and deductibles. If you receive full Medicaid benefits, those often cover the remainder of the cost.
What’s the difference between a D-SNP and a C-SNP?
Medicare has Special Needs Plans outside of the D-SNP. One is the C-SNP or Chronic Condition Special Needs Plan. C-SNPs are only for those with a single chronic condition or related group of chronic conditions that qualify them for the plan. D-SNPs are available to those who qualify for both Medicare and Medicaid
Do I need to pick a primary care physician (PCP) with a D-SNP?
Yes, D-SNPs do require choosing a primary care physician (PCP). When you enroll in a D-SNP, use our plan comparison tool and search by physician to find a plan that works with your preferred providers.
Note: D-SNPs do not require PCP referrals for specialist visits.
Can I choose a separate Part D plan with my Medicare Advantage D-SNP?
Because all Dual Eligible Special Needs Plans are required to provide prescription drug coverage, you will not be able to enroll in a separate Medicare Part D prescription drug plan (PDP).
Clearlink Insurance represents Medicare Advantage HMO, PPO, PFFS, and PDP organizations that have a Medicare contract. Enrollment depends on the plan's contract renewal.
We do not offer every plan available in your area. Currently we represent 7 organizations which offer 275 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Enrollment in a plan may be limited to certain times of the year unless you qualify for a Special Enrollment Period or you are in your Medicare Initial Enrollment Period.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
For accommodations of persons with special needs at meetings call TTY 711.
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