Dual Eligible Special Needs Plans (D-SNPs) What are they and who is eligible?

Dual Eligible Special Needs Plans (D-SNPs) enroll beneficiaries who are entitled to both Medicare (Title XVIII) and Medical Assistance from a State Plan under Title XIX (Medicaid), and offer the opportunity of enhanced benefits by combining those available through Medicare and Medicaid.

D-SNP eligibles can Join during an enrollment period or Special Enrollment Period (SEP). A unique aspect of D-SNP plans is members can move from plan to plan each month as long as they are Medicaid Eligible. For those that lose Medicaid Eligibility, they have a SEP beginning the month they receive the notice of the loss of eligibility, plus two additional months to make an enrollment choice. This means you can enroll eligible in D-SNP plans all year round not just during the annual MA Open Enrollment Period.

A key aspect of of D-SNP plans are the Models of Care (MOCs), which are considered a vital quality improvement tool and integral component for ensuring that the unique needs of each beneficiary enrolled in a Special Needs Plan (SNP) are identified and addressed. Key areas of the care coordination aspect of the MOC Include conducting Health Risk Assessments (HRA’s) and working with an Interdisciplinary Care Team (ICT) who is tasked with coordinating delivery of services and benefits to D-SNP members. The ICT team consults with the member and physicians to develop a comprehensive individualized care plan that addresses that person’s specific needs.

Types of D-SNPs

Although D-SNPs are available to beneficiaries in all Medicaid eligibility categories, D-SNPs may further restrict enrollment to beneficiaries in certain Medicaid eligibility categories. CMS divides D-SNPs into the following four categories, according to the types of beneficiaries that the SNP enrolls:

Medicaid eligibility categories:

In addition to D-SNP plans there are also Chronic Special Needs Plans (CSNP) for members with disabling chronic conditions and Institutional Special Needs Plans (ISNP) for beneficiaries who are institutionalized.

DSNP plans are NOT Medicare Medicaid Plans (MMPs)

A Medicare Advantage Medicare-Medicaid Plan (MMP) is a private health plan designed to provide integrated and coordinated Medicare and Medicaid benefits for dual eligible Medicare beneficiaries.

Unlike a Medicare Advantage Dual Eligible Special Needs Plan (D-SNP), MMPs only serve full benefit dual (Medicare/Medicaid) eligible beneficiaries and some additional limitations may apply (such as state-specific requirements). Medicare-Medicaid plans were introduced in 2014 and are only offered in a few counties across the country.