Definition · Pharmacy, Medicare enrollment, and access

Dual Eligible Special Needs Plan (D-SNP)

A Dual Eligible Special Needs Plan (D-SNP) is a Medicare Advantage plan only for people who have both Medicare and Medicaid. It covers Medicare benefits and coordinates with the person's state Medicaid program. Every D-SNP must hold a contract with the state Medicaid agency, and some fully integrate Medicare and Medicaid benefits under one plan.

What a D-SNP is

Special Needs Plans are Medicare Advantage plans limited to specific groups. A D-SNP serves dual-eligible people, meaning those enrolled in both Medicare and Medicaid. It provides Medicare Part A, Part B, and Part D coverage, and it helps coordinate the Medicaid benefits the person also gets. Many offer extra benefits such as dental, vision, or transportation.

Coordination with the state is built in. Every D-SNP must have a contract with the state Medicaid agency, which sets how the two programs work together. Integration varies. Some plans only coordinate. Others, such as fully integrated plans, cover both Medicare and Medicaid benefits under one organization. What is available depends on the state.

Dual-eligible members often have more chronic conditions and more medications, and they can be harder to reach. That makes outreach for care gaps, adherence, and annual visits harder. Rivvi is a HIPAA-compliant AI workspace where plan and practice teams can analyze member lists. Its action layer handles calls and texts in Spanish plus 30 more languages.

Questions

D-SNPs, answered

Who qualifies for a D-SNP?

People who have both Medicare and Medicaid. Some D-SNPs accept everyone with both programs. Others limit enrollment to certain Medicaid categories, such as full Medicaid benefits, depending on the plan and the state. The person must also live in the plan's service area.

D-SNP vs regular Medicare Advantage: what is the difference?

A regular Medicare Advantage plan is open to anyone with Medicare in its service area. A D-SNP is open only to dual-eligible people and must coordinate with state Medicaid under a contract with the state. Its benefits and care coordination are built around that population.

Can people with Medicare and Medicaid change plans during the year?

People with Medicaid or Extra Help have their own Special Enrollment Period rules, separate from the general ones. Those rules have changed in recent years, so check the current rule on Medicare.gov or with the state Medicaid office before making a change.

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What a D-SNP is

D-SNPs, answered

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