A Dual Eligible Special Needs Plan, or D-SNP, is a good choice if you have both Medicare and Medicaid. It can make it easier to understand your benefits and get the care you need.
What's a D-SNP?
A D-SNP is a type of Medicare Advantage plan for people who have both Medicare and Medicaid. It puts your hospital, medical and prescription drug coverage in one plan:
- Hospital care: Helps pay for stays at the hospital, care at a nursing center and some health care at home
- Medical care: Helps pay for doctor and specialist visits and medical equipment, such as wheelchairs
- Prescription drugs: Helps pay for your medicines
- Care support: Gives you a care management team to help with things like making appointments and understanding your medicines
- Added benefits: Plans include dental, vision and hearing and an Extra Benefits Card to pay for certain over-the-counter (OTC) health items
Aetna® Medicare offers a D-SNP to help you get your Medicare and Medicaid benefits in one plan.
Learn more about an Aetna Medicare D-SNP
Who can get a D-SNP?
You can get a D-SNP if you have both Medicare and Medicaid. You must also:
- Have Medicare Parts A and B
- Have Medicaid or help from a state Medicaid program
- Live where the plan is offered
- Meet the plan’s rules for joining
Each state has its own Medicaid program and D-SNP choices. Check the plan’s rules before you join.
How much does a D-SNP cost?
What you pay for a D-SNP depends on the plan you choose and if you’re eligible for Medicaid benefits.
For example, plans have a $0 monthly premium. This is the amount you pay each month for your plan. But you may still have costs for care or medicine. If you have Medicare and Medicaid (dual eligibility), most of these costs are covered.
You may have copays or other costs when you get care or medicine. Medicaid can help pay some or most of these costs. Check the plan details to see what you’ll pay.
What should I check before choosing a D-SNP?
Before you choose a D-SNP, make sure the plan fits your health needs and is offered where you live.
Here’s what to check:
- Doctors and hospitals: Are your providers in the plan’s network?
- Prescription drugs: Does the plan cover your medicines?
- Pharmacies: Is the pharmacy you use in the plan?
- Dental, vision and hearing: What care and services are included?
- Rides: Does the plan offer rides to medical visits?
- Everyday items: Does the plan include an allowance to help pay for approved over-the-counter health items?
- Plan costs: What will you pay each month for your plan, and when you get care?
- Your location: Is the plan offered where you live?
- Care support: Do you need a care team help you manage your care?
How do I enroll in a D-SNP?
To enroll in a D-SNP, first make sure you have both Medicare and Medicaid. Then check if a D-SNP is offered where you live.
You can enroll when you first get Medicare or during a Medicare enrollment period. You may also qualify for a Special Enrollment Period (SEP) because you have both Medicare and Medicaid.
Common questions about a D-SNP
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Medicare and Medicaid are two different health care programs.
Medicare is health insurance for people age 65 or older. Some younger people can also get it if they have a disability or certain health conditions.
Medicaid helps people with low income pay for health care. Each state has its own rules.
If you have both programs, Medicare pays first for covered care. Medicaid can then help pay some costs Medicare does not cover. People who have both are called dual eligible.
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Many people with a D-SNP also get Medicare Extra Help because they have both Medicare and Medicaid. Extra Help, also known as the Medicare Low-Income Subsidy federal program, helps people with low income and savings pay Medicare Part D drug costs. It can lower what they pay for their medicines.
Who qualifies for Medicare Extra Help?
Medicare signs you up for Extra Help if you have one of these benefits:
You have full Medicaid coverage.
Your state helps pay your Medicare Part B premium through a Medicare Savings Program.
You get Supplemental Security Income (SSI), a monthly payment for people with low income and resources.
If you do not get one of these benefits, you’ll need to apply through Social Security.
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If you’re under age 65, you usually need a disability or certain health condition like kidney failure to get Medicare. But having a disability does not let you join a D-SNP. You must also:
Have Medicare Parts A and B
Have Medicaid
Live where the plan is offered
Meet the plan’s rules
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Yes, if you have Medicare Parts A and B and Medicaid. You must also live where the D-SNP is offered and meet the plan’s rules.
You can still have health coverage from your job. If you have coverage from your job, it may pay for your care first. Then Medicare and Medicaid can help pay what's left. If you leave the job, you can get COBRA. COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. It’s a law that can let you keep health coverage from a former job for a short time. You usually pay the full cost.
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No, Medicare coverage is for one person at a time. You and your spouse must each qualify for your own plan. If one of you has Medicare and Medicaid but the other has Medicare only, you may need different types of plans.
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If you lose Medicaid, you’ll no longer qualify to stay in your D-SNP. Your plan will tell you how long you can stay enrolled and what steps to take.
You might be able to get a Special Enrollment Period (SEP). This gives you a certain amount of time to choose another Medicare Advantage plan, join a Medicare drug plan (such as a PDP) or go back to Original Medicare (Parts A and B).
Already a member?
If you already have a plan:
- Log in to your secure member website
- Contact Member Services if you have questions about your benefits.
Disclaimer
This material is for informational purposes only and is not medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Contact a health care professional with any questions or concerns about specific health care needs. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to our website.