Globalcare ConsultingDual eligible · D-SNP
Dual Special Needs Plans (D-SNP)
A D-SNP is a type of Medicare Advantage plan built for people who have both Medicare and Medicaid. It combines your Medicare benefits, prescription drug coverage, and Medicaid coordination into one plan — typically with a $0 premium and extra benefits Original Medicare doesn’t include. Roughly 13.6 million Americans hold both forms of coverage.
Do you qualify?
The simplest test: check your wallet. If you carry both cards, you're likely eligible.
Your Medicare card
You’re enrolled in Medicare Part A and Part B — through age (65+) or a qualifying disability.
Your Medicaid card
You qualify for Medicaid in your state. Eligibility is set by your state and depends on income, assets, age, and other factors.
You must also live in the plan’s service area. D-SNPs are not available everywhere, and states decide which plans carriers may offer — so availability varies by county.
How the two programs work together
Having both isn't duplicate coverage. They pay in a specific order.
Medicare is the primary payer. It covers your hospital, medical, and prescription costs first, exactly as it would for anyone else.
Medicaid is the secondary payer. Depending on your eligibility level, it helps pay some or all of what Medicare leaves behind — premiums, deductibles, copays, and coinsurance.
Full dual eligible
You receive full Medicaid benefits. Your state may cover your Part A and B premiums and nearly all remaining out-of-pocket costs.
Partial dual eligible
You qualify for help through a Medicare Savings Program but not full Medicaid medical benefits. Some out-of-pocket costs may remain, and not every D-SNP accepts partial duals.
What a D-SNP adds
Every D-SNP must cover everything Original Medicare covers. Most add considerably more — though benefits vary by plan and by market.
Prescription drugs
Part D coverage is built in. You don’t need — and shouldn’t buy — a separate drug plan.
Dental, vision, hearing
Routine exams, cleanings, glasses, and hearing aids are commonly included.
Care coordination
A care coordinator helps align your Medicare and Medicaid benefits so you’re not navigating two systems alone.
$0 or low premiums
Most D-SNPs carry $0 premiums, deductibles, and copays for full duals.
Extra Help for drugs
Medicaid enrollment automatically qualifies you for Extra Help (the Low-Income Subsidy), which covers most drug costs.
Everyday allowances
Many plans include a monthly allowance for over-the-counter items. Availability varies by plan and market.
One thing to watch every year
The most common way people lose D-SNP coverage has nothing to do with Medicare.
Renew your Medicaid — every single year.
Your D-SNP eligibility depends on holding both Medicare and Medicaid. Your state reviews Medicaid eligibility annually and mails you a renewal notice. Return it promptly.
If your Medicaid lapses, you can lose D-SNP eligibility — and you may start owing for services Medicaid previously covered. Losing Medicaid is generally a qualifying event that opens a Special Enrollment Period, so call your agent right away rather than waiting.
Enrolling in a D-SNP does not reduce or replace your Medicaid benefits. It coordinates them.