Dual Special Needs Plan: For people with Medicare & Medicaid

Some people are eligible to have both Medicare and Medicaid. These people are considered “dual eligible,” and they also qualify to enroll in a special kind of Medicare Advantage plan known as a Dual Special Needs Plan (D-SNP).

A Dual Special Needs Plan is a special kind of Medicare Advantage coordinated-care plan. It is an all-in-one plan that combines your Medicare Part A and Part B benefits, your Medicare Part D prescription drug coverage, your Medicaid benefits and additional health benefits such as vision, dental or fitness.

You can get a Dual Special Needs Plan if you meet the following qualifications:

1. You are eligible Medicare and Medicaid and have both.
2. You have Medicare Part A and Part B.
3. You live in the plan’s area.

Just like any other Medicare Advantage plan, a Dual Special Needs Plan will include coverage for Medicare Part A and Part B. It will also include Part D prescription drug coverage and extra benefits not provided by either Medicare or Medicaid.

Examples of extra benefits a Dual Special Needs Plan may provide include:

• Credits to buy health products
• Transportation assistance
• Care coordination via a personal care coordinator
• Personal emergency response system (PERS)
• Tele-health options such as virtual medical visits with your doctor
• Worldwide emergency coverage

The extra benefits offered will vary by plan, provider and location.

If you qualify for Medicaid and are enrolled in Medicare, you may be able to enroll in a Dual Special Needs Plan during the first nine months of the year in a Special Enrollment Period, rather than the Medicare Annual Enrollment Period (AEP) in the fall.