What is a D-SNP?

A Dual Eligible Special Needs Plan, or D-SNP, is designed specifically for people who are eligible for both Medicare and Medicaid. This is a Medicare Advantage (Part C) plan that works with your Medicaid health plan. D-SNPs began operating in 2006.

The dual eligible population falls into two groups, full duals and partial duals. All dual eligible beneficiaries qualify for full Medicare benefits, but the level of Medicaid benefits can vary, depending on income limits and asset levels. 

Dual eligible plans are tailored to meet the needs of individuals with complex health conditions or those who require additional support.

Full duals

People who qualify for both Medicare and full Medicaid coverage are considered dual eligible or full duals. If your D-SNP is run by the same health plan as your Medicaid health plan, the health plan will coordinate all your Medicaid and Medicare health benefits.

Fully integrated dual eligible special needs plans (FIDE SNPs) consolidate care for dually eligible beneficiaries under a single managed care organization. They provide coverage from a Medicare managed care plan that coordinates all covered Medicare and Medicaid benefits, including long-term services and supports, in one health plan. Starting in plan year 2025, all FIDE SNPs will be required by CMS to have exclusively aligned enrollment (EAE), which means that all FIDE SNPs will be Applicable Integrated Plans (AIPs) by plan year 2025.

Though Medicare and Medicaid cover many of the same services, Medicare pays first for the Medicare-covered services that are also covered by Medicaid. Medicaid pays last, after Medicare and any other health insurance you have.

If you are dual eligible, Medicare also covers your prescription drugs. Your Medicare drug plan will cover your drug costs instead of Medicaid. Medicaid may still cover some drugs that Medicare doesn’t cover. 

Partial duals 

Partial dual eligible beneficiaries are enrolled in Medicare Part A and Part B, and in a Medicare Savings Program (MSP). MSPs, like the Qualified Medicare Beneficiary program (QMB), cover costs such as Part A premiums and Part A and B deductibles, coinsurance, and copayments, depending on the program. 

D-SNP benefits

Medicare Advantage D-SNPs often provide additional benefits beyond what’s covered by Original Medicare with the ultimate goal to improve care and lower cost. Aside from extra benefits, the best thing about Medicare Advantage D-SNPs is that they coordinate better with Medicaid. 

D-SNP extra benefits may include:

• Grocery allowance
• Prepaid flex card to use toward utilities
• Prescription drug coverage
• Over-the-counter (OTC) products
• Dental, vision, and hearing allowances

Are you eligible for D-SNP Medicare?

To be entitled to Medicare, you must be a U.S. citizen or a permanent legal resident, and answer yes to at least one of the following questions:

• Are you age 65 or older and eligible to receive Social Security benefits?
• Are you under age 65, permanently disabled, and have been receiving Social Security Disability Insurance (SSDI) payments for at least two years?
• Do you receive continuing dialysis for permanent kidney failure or need a kidney transplant?
• Do you have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease?

You can join a Medicare Advantage D-SNP if:

• You have Medicare Part A and Part B;
• You have Medicaid or are in a Medicare Savings Program (MSP); and
• You live in the service area of the plan.

Important note: Federal government rules require that if you join a Medicare Advantage plan like Sentara Medicare, and you want Medicare prescription drug coverage, you must get that drug coverage from your Medicare Advantage plan. In addition, Medicare has special rules that dictate when you can join, change, or leave a Medicare Advantage plan.

What’s different with the Sentara Medicare D-SNP

Enrollees eligible for a Sentara Medicare D-SNP have access to our high-quality network of more than 50,000 doctors, specialty providers, and healthcare facilities.

Sentara Medicare D-SNPs offer what’s important to you:

• Personal attention from a care coordinator
• Prescription drug coverage
• Prepaid flex card to use toward utilities
• Monthly grocery allowance*
• Over-the-counter (OTC) products

If you have Medicare and Medicaid and are living with special healthcare needs or limited income, see if you are eligible for Sentara Community Complete (HMO D-SNP). For those that are partial dual eligible, Sentara Community Complete Select (HMO D-SNP) may be the best plan for you.

Call 1-877-550-3285 (TTY: 711) or visit sentaramedicare.com/dsnp 

October 1–March 31 | 7 days a week | 8 a.m.–8 p.m.
April 1–September 30 | Monday–Friday | 8 a.m.–8 p.m.

Sources: cms.gov, dmas.virginia.gov, macpac.gov, justiceinaging.org

*Members with chronic condition(s) that meet certain criteria may be eligible for this special supplemental benefit. Y0174_1124_SHPWD_460017_C