DSNP Plans
Dual Eligible Medicare + Medicaid Plans
Do You Have Both Medicare and Medicaid?
You may qualify for a Dual Eligible Special Needs Plan, also called a D-SNP. These Medicare Advantage plans are designed for people who have both Medicare and Medicaid and may include extra benefits, lower costs, and coordinated support.
Plan availability, benefits, costs, provider networks, and Medicaid rules vary by state, county, and individual eligibility.
A Dual Plan May Help With:
Medicare + Medicaid Coordination
Your benefits may be coordinated through one Medicare Advantage plan.
Lower Out-of-Pocket Costs
Depending on your Medicaid level, you may have help with premiums, copays, and other costs.
Extra Benefits
Some plans may include dental, vision, hearing, OTC, transportation, meals, or other benefits.
What Is a Dual Eligible Medicare Plan?
A Dual Eligible Special Needs Plan, often called a D-SNP, is a type of Medicare Advantage plan for people who qualify for both Medicare and Medicaid. These plans are designed to help coordinate your Medicare benefits, Medicaid benefits, prescription drug coverage, and extra plan benefits.
For many people, having Medicare and Medicaid can feel confusing because the programs work differently. A dual plan may make it easier to understand your coverage, use your benefits, and get help reviewing doctors, prescriptions, and costs.
For People With Medicare and Medicaid
You generally must have Medicare Part A, Medicare Part B, and some level of Medicaid eligibility to qualify.
County-Based Availability
Dual plans are not available everywhere. Plan options depend on your state, county, Medicaid level, and service area.
Benefits Can Vary
Dental, OTC, transportation, food cards, utilities, and other benefits vary by plan and eligibility.
Who May Qualify for a Dual Plan?
You may qualify if you have Medicare and Medicaid. However, Medicaid has different eligibility levels, and not every Medicaid category qualifies for every dual plan.
You Have Medicare
You must usually be enrolled in Medicare Part A and Part B to join a Medicare Advantage dual plan.
You Have Medicaid
Medicaid may help pay certain Medicare costs and may provide additional state-based benefits.
A Plan Is Available Where You Live
Dual plan options are based on your ZIP code, county, provider network, and Medicaid eligibility level.
What Benefits Can Dual Plans Include?
Dual eligible plans may include extra benefits beyond Original Medicare. The exact benefits depend on the plan, carrier, county, and your Medicaid eligibility.
Plan Medicare can help you compare your options before you make any changes, including doctors, prescriptions, hospitals, pharmacies, and extra benefits.
Dental Benefits
May include preventive and comprehensive dental coverage.
Vision and Hearing
May help with eye exams, eyewear, hearing exams, or hearing aids.
OTC Allowance
May include an allowance for eligible over-the-counter health items.
Transportation
Some plans may help with rides to approved medical appointments.
Prescription Drug Coverage
Most dual plans include Medicare Part D prescription drug coverage.
Care Coordination
Plans may offer support to help coordinate your care and benefits.
Why Review Your Dual Plan Options?
Many people with Medicare and Medicaid do not realize they may have more than one coverage option. The right plan can depend on your doctors, prescriptions, Medicaid level, county, and personal needs.
Check Your Doctors
We can help review whether your doctors, specialists, and hospitals are in the plan network.
Review Your Prescriptions
We’ll check your medications, pharmacy options, and prescription drug coverage.
Compare Extra Benefits
We’ll help you understand dental, OTC, transportation, vision, hearing, and other plan benefits.
How Plan Medicare Helps
Our licensed Medicare advisors help you understand your options at no cost to you. We’ll explain how dual plans work and help you compare what is available in your area.
Confirm Eligibility
We’ll help determine whether you may qualify based on your Medicare and Medicaid status.
Compare Plans
We’ll review plan benefits, doctors, prescriptions, pharmacies, costs, and county availability.
Enroll With Confidence
If a plan is a good fit, we can help with enrollment and continue to support you after your plan begins.
Frequently Asked Questions
Common questions about Medicare, Medicaid, and Dual Eligible Special Needs Plans.
What is a Dual Eligible Special Needs Plan?
A Dual Eligible Special Needs Plan, or D-SNP, is a Medicare Advantage plan for people who have both Medicare and Medicaid. These plans are designed to coordinate benefits and may include extra support.
Do I need both Medicare and Medicaid to qualify?
Yes. Dual plans are generally for people who have Medicare and Medicaid. Your exact Medicaid level can affect which plans you qualify for.
Can I keep my doctors?
It depends on the plan network. Before making any change, Plan Medicare can help check your doctors, specialists, hospitals, and pharmacies.
Do dual plans include prescription drug coverage?
Most Dual Eligible Special Needs Plans include Medicare Part D prescription drug coverage, but the covered drug list and pharmacy rules can vary.
Can I change into a dual plan during the year?
People with Medicare and Medicaid may have special enrollment opportunities, but the timing and rules depend on your situation. A licensed advisor can help review your options.
Does it cost anything to work with Plan Medicare?
No. Our Medicare guidance is provided at no cost to you. If you enroll through our agency, we may be compensated by the insurance carrier.
Not Sure If You Qualify for a Dual Plan?
We can help you review your Medicare and Medicaid status, compare available dual plans, and understand your options before you make a decision.
Plan Medicare is not connected with or endorsed by the United States government or the federal Medicare program. Enrollment depends on eligibility, plan availability, and CMS rules. Benefits, provider networks, prescription coverage, costs, and availability vary by service area and plan. Medicaid eligibility and benefits vary by state and individual circumstances. This page is for educational purposes only and does not guarantee eligibility, enrollment, or specific benefits. We do not offer every plan available in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Program to get information on all of your options.