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2019 Dual Special Needs Plans (DSNPs)

A DSNP is a special type of Medicare Advantage Prescription Drug Plan (MA-PD) that provides benefits to members who qualify for Medicare and are receiving full Medicaid benefits and/or assistance with Medicare premiums or Medicare Parts A & B cost sharing through one of the Medicare Savings Program (MSP) categories. Members must reside in a county where Aetna offers a DSNP.

Policies and procedures
All DSNP plans are required to have an approved Model of Care. Providers must take the mandatory Model of Care training required by CMS each year.

Member eligibility and benefits
To become eligible, members should:

  • Show their DSNP member ID card and their state-issued Medicaid card
  • Select a primary care physician

There are no out-of-network benefits unless the member follows the approval process by contacting Member Services directly.

Provider claims processing
Member cost sharing: Depending on the member’s MSP eligibility, they may have a cost-share responsibility. Providers may not balance bill members who do not have cost-share responsibility (including QMB-only).

If you have questions, contact us.