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Hero Selling DSNP

D-SNP - Dual Eligible Special Needs Plans

The Medicare landscape is constantly evolving, and within it, a critical group remains largely overlooked: the Dual Eligibles. This group, comprising around 12 million Americans or 20% of the Medicare demographic, finds itself at the crossroads of Medicare and Medicaid eligibility.Guide to DSNP Video Thumbnail(small)

Surprisingly, fewer than 30% of Dual Eligibles are taking advantage of Medicare Advantage or Special Needs Plans (D-SNPs). This gap has sparked a significant increase in the availability of Special Needs Plans and brought this demographic to the forefront of Medicare Advantage providers' strategies across the country.

For licensed agents specializing in Medicare offerings, delving into the Dual Eligible/Special Needs Plan arena is a strategic move. The distinct enrollment periods and rules for D-SNPs open the door to continuous sales opportunities, bypassing the constraints of the Annual Enrollment Period (AEP) and the Open Enrollment Period (OEP).


What is a D-SNP? 

Dual Eligible Special Needs Plans, commonly known as D-SNPs, represent a unique category within Medicare Advantage plans, tailored specifically for individuals who simultaneously qualify for both Medicare and Medicaid.

The availability of D-SNPs, along with the scope of benefits they offer, is determined by state regulations. Typically, these plans might include a variety of benefits without any monthly premiums, such as:

  No-cost premiums

  Support for coordinating care

  Benefits for vision and hearing care

  Quarterly allowances for over-the-counter items

  Transportation services

  Access to telehealth

  Gym memberships

  Coverage for prescription drugs under Part D

D-SNPs consolidate hospital care (covered under Medicare Part A), medical services (covered under Medicare Part B), and prescription medication (covered under Medicare Part D) into a cohesive plan. These plans often provide additional social services to assist in managing the dual benefits of Medicare and Medicaid for beneficiaries.

It’s important to note the difference between a D-SNP and a Medicare Advantage Medicare-Medicaid Plan (MMP). D-SNPs cater to a broader dual-eligible population, while MMPs are designed exclusively for those fully eligible for both Medicare and Medicaid, subject to more restrictive state-specific criteria. MMPs, introduced in 2014, are available in limited counties nationwide.

D-SNPs are categorized into five distinct types, each offering different levels of Medicaid coverage:

  All Dual

  Full Benefit

  Medicare Zero Cost Sharing

  Dual Eligible Subset

  Dual Eligible Subset Medicare Zero Cost Sharing

The specifics of these categories will be elaborated on in the following sections.

Who is Eligible for a D-SNP

D-SNP qualification

Eligibility for the Dual Eligible Special Needs Plan (D-SNP) requires simultaneous qualification for both Medicare and Medicaid programs.

To be eligible for Medicare, individuals must either be aged 65 or older, or possess a qualifying disability.

Medicaid eligibility hinges on an individual's financial status, necessitating that both their income and assets do not exceed specific thresholds set by their respective state.

The D-SNP program specifically caters to this intersecting demographic, characterized by the following attributes:

1. Members are simultaneously enrolled in both Medicare and Medicaid, fulfilling the eligibility criteria for each.

2. This group represents a more susceptible segment of Medicare beneficiaries.

3. It encompasses individuals both above and below the age of 65, including those who are eligible due to disability.

4. Their healthcare needs often lead to higher costs.

5. Eligibility for Medicaid typically signifies lower income levels and a self-reported poorer health status in comparison to other Medicare beneficiaries.


What are the Related Medicaid Eligibility Categories?

Individuals who are dual eligible can be categorized into one of seven distinct Medicaid eligibility brackets. It's important to note that eligibility criteria can differ from state to state, introducing variations in these categories. Broadly, the categories for Medicaid eligibility are as follows:

  Qualified Medicare Beneficiary (QMB) Only

  QMB Plus

  Specified Low-Income Medicare Beneficiary without additional Medicaid (SLMB) Only

  Specified Low-Income Medicare Beneficiary with additional Medicaid (SLMB) Plus

  Qualifying Individual (QI)

  Qualified Disabled and Working Individual (QDWI)

  Other Full Benefit Dual Eligible (FBDE)

Below, you'll find a chart detailing which D SNP types individuals might be eligible for, based on their Medicaid category. It's worth mentioning that Special Needs Plans may not be accessible in all areas across the United States. For further information on these or any other plans, we encourage you to reach out to our knowledgeable marketing team.


dual eleigible medicaid category chart

D-SNP Type Definitions 

All-Inclusive Dual Eligible Special Needs Plans:

The All-Inclusive Dual (D-SNP) caters to beneficiaries who qualify for Medicare Advantage and are also eligible for Medicaid support through a State or Territorial plan. This type of D-SNP is inclusive, welcoming all dual eligible individuals, ranging from those with comprehensive Medicaid benefits to those receiving limited cost-sharing support.

Comprehensive Benefit D-SNPs serve individuals eligible for:

Full Medicaid benefits for any given month under any eligibility category specified by the Medicaid State Plan, or comprehensive benefits through a demonstration under Section 1115 of the Act; or, Medical support under Section 1902(a)(10)(C) of the Act (for the Medically Needy) or Section 1902(f) of the Act (for states employing stricter eligibility criteria than the SSI program), provided the individual was eligible for medical support at any time during the month.

Medicare Zero Cost-Sharing D-SNPs:

This D-SNP variant restricts its enrollment to Qualified Medicare Beneficiaries (QMBs) and QMBs receiving comprehensive Medicaid benefits (QMB+), which are the dual eligible beneficiary categories exempt from financial responsibility for Medicare Parts A and B cost-sharing. Notably, QMB-only individuals are not entitled to full Medicaid benefits and might incur Medicaid cost-sharing.

Targeted Dual Eligible Special Needs Plans / Medicare Zero Cost Sharing D-SNPs:

Targeted Dual Eligible D-SNPs may either incorporate cost sharing (Targeted Dual Eligible Subset) or exclude cost sharing (Targeted Dual Eligible Subset Medicare Zero Cost Sharing), providing flexibility in plan design to meet diverse beneficiary needs.

Fully Integrated Dual Eligible Special Needs Plans:

Authorized by the Affordable Care Act (ACA) in 2010, Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs) represent a unique D-SNP aimed at seamlessly integrating Medicare and Medicaid services. FIDE SNPs, however, are available on a much more limited basis compared to other types.

FIDE SNPs are required to fulfill specific criteria, notably contracting with the state to offer Medicaid long-term care benefits and services in alignment with state policy through risk-based financing mechanisms. They are also tasked with coordinating the delivery of both Medicare and Medicaid health and long-term care services. Of all D SNPs, only 11 percent (45 out of 393 plans) qualify as FIDE SNPs. For additional information, refer to chap. 16b, section 40.4.3.

D-SNP Enrollment 

Individuals eligible for D-SNP (Dual Special Needs Plans) have two key windows for enrollment: the standard Medicare Advantage enrollment period and the Special Enrollment Period (SEP).

A pivotal update by the Center for Medicare and Medicaid Services (CMS) has reshaped the landscape of the LIS/Dual Special Enrollment Period. Effective from January 1, 2019, those qualifying for LIS/Dual SEP now enjoy the flexibility to alter their coverage once each quarter during the first three quarters of the year, specifically in the periods of:

  January to March

  April to June

  July to September

It's important to note that the fourth quarter (October to December) is excluded from the LIS/Dual SEP eligibility.

Upon submitting an enrollment request, the activation of the new coverage plan kicks in on the first day of the following month. According to CMS rules, the SEP's utilization is determined by the month in which the coverage change is elected. For example, if a choice is made in March for an April start date, the SEP for the first quarter is considered utilized, not the second quarter.

Furthermore, individuals experiencing changes in their Dual or LIS status—whether it's gaining, losing, or altering their eligibility—have a single chance to make a plan selection within three months of the change, or from when they're notified, whichever comes later.

For those who find themselves no longer eligible for Medicaid, an SEP window opens from the month they're informed about their ineligibility, extending an additional two months for them to choose a new plan.

Remember, eligibility for a Special Needs Plan is contingent on meeting specific criteria. Should an individual's circumstances change rendering them ineligible for their current plan, they're granted a Special Election Period. This allows them to either transition to a different Medicare Advantage plan or revert to Original Medicare.

Additionally, there's an SEP designed for individuals to revise their D-SNP once in each of the year's first three quarters.

Navigating these options can be complex for your clients. Your role as a licensed agent in clarifying these choices is crucial, and it significantly influences the loyalty of your clients.

Where to Find DSNP Prospects

Seniors Bingo

Individuals eligible for Dual Special Needs Plans (D-SNPs) typically inhabit urban or economically challenged regions. Their reliance on Welfare and Social Security benefits provides a valuable indicator for your outreach efforts.

The timing and location of your search are equally critical. Below are tailored suggestions to guide your initial steps.

In the first half of the month, focus on:

  Discount outlets

  Dollar shops

  Flea markets

  Second-hand stores

During the latter half, shift attention to:

  Food assistance centers

  Community soup kitchens

  Local food pantries

Consistently throughout the month, engage at:

  Community hubs

  Affordable housing complexes

  Food pantries again due to their critical role

  Religious organizations

  Charitable gatherings

Remember, this audience faces multiple hurdles and will require extra effort from you to grasp the full advantages of D-SNPs. Success in this arena belongs to those with a genuine desire to make a difference.

Merely distributing flyers and business cards is not enough to foster meaningful connections. Direct, on-the-ground interaction is essential for effectively communicating with this demographic, who often benefit from additional support and clarity.

Investing time and showing up in their environment can be either challenging or rewarding, influenced largely by your approach and attitude.

If you're open to setting up information booths at local events, or lending a hand at community centers and food banks, then engaging with the D-SNP market could significantly benefit your business.


What is the DSNP Disclaimer?

According to CMS rules (MMG Appendix 2), the following disclaimer must be used on all D-SNP marketing materials that mention cost-sharing information to residents in the United States: Premium, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.

This disclaimer is not required on material for beneficiaries who live in the territories.

Is the DSNP Market Right for Me?

Volunteer group caringDual Eligible beneficiaries can join or switch D SNPs more often than other plans, so a human touch is required.

They will need to know you have their best interest in mind and that you can genuinely help them. At the end of the day it’s not rocket science.

Like any group of customers, the only way to keep them from moving their business elsewhere is by taking good care of them.

D SNPs can be a great way to grow your business all year round. By being a go to resource on special needs plans you will be rewarded by a loyal group of clients.

Note: Ensure you are following all CMS guidelines to stay compliant. The Special Needs Plan FAQ from CMS can also help answer any questions you may have. 

*For agent use only.  *Not affiliated with the U.S. Government or federal Medicare program.


Precision Senior Marketing works with top licensed agents around the country. Our portfolio is quality-focused to ensure we are offering only the best products. When you contract with us you can be assured you not only have a direct contract with a leading Medicare advantage FMO, but a partner dedicated to your growth.