Understanding Dual Eligible Special Needs Plans (D-SNPs)

Understanding Dual Eligible Special Needs Plans (D-SNPs) with FTJ Senior Insurance 

Dual Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage plan designed specifically for people who qualify for both Medicare and Medicaid. These plans offer extra support, care coordination, and benefits tailored to help you get the most from your healthcare coverage. 

What Is a Dual Eligible Special Needs Plan (D-SNP)? 

A D-SNP is a Medicare Advantage plan for individuals who are “dual eligible”—meaning you qualify for both Medicare (due to age or disability) and Medicaid (based on income and resources). These plans are offered by Medicare-approved private insurance companies, including FTJ Senior Insurance. 

What Does a D-SNP Cover? 

• All Original Medicare Benefits: D-SNPs must cover everything that Original Medicare (Parts A & B) covers. 

• Prescription Drug Coverage: Most D-SNPs include Medicare Part D prescription drug coverage. 

• Medicaid Benefits: D-SNPs work with your state Medicaid program to coordinate benefits and help reduce out-of-pocket costs. 

• Extra Benefits: Many plans offer dental, vision, hearing, transportation, over-the-counter allowances, and more. 

• Care Coordination: Access to care managers who help you navigate your benefits, schedule appointments, and manage your health. 

Who Can Enroll in a D-SNP? 

You must: 

• Be enrolled in Medicare Part A and Part B 

• Have full or partial Medicaid benefits in your state 

• Live in the plan’s service area 

 

Advantages of Dual Eligible Special Needs Plans 

• Lower Out-of-Pocket Costs: Medicaid may help pay for premiums, copays, and other expenses. 

• Comprehensive Coverage: Includes hospital, medical, and prescription drug benefits. 

• Extra Support: Care coordination and additional benefits not available with Original Medicare alone. 

• Tailored to Your Needs: Plans are designed to help you get the most from both Medicare and Medicaid. 

Disadvantages of D-SNPs 

• Eligibility Required: Only available to those who qualify for both Medicare and Medicaid. 

• Provider Networks: You may need to use doctors and hospitals in the plan’s network. 

How Much Do D-SNPs Cost? 

Most D-SNPs have low or $0 monthly premiums, and Medicaid may help cover many out-of-pocket costs. Costs can vary by plan and location. 

When Can You Enroll? 

You can enroll in a D-SNP during: 

• Your Initial Enrollment Period (when you first become eligible for Medicare) 

• The Annual Enrollment Period (October 15 – December 7) 

• A Special Enrollment Period (if you gain, lose, or change Medicaid eligibility) 

 

Have questions or want to see if you qualify? 
Contact FTJ Senior Insurance today—our licensed agents are here to help you find the right Dual Eligible Special Needs Plan for your needs.