How to enroll in a Dual Eligible Special Needs Plan, or D-SNP (2024)

Get step-by-step guidance on how to qualify for both Medicare and Medicaid, and enroll in a low- to no-cost D-SNP almost any time of year

Comparing health plans. Choosing between benefit options. Confirming your eligibility. Navigating all the paperwork. Enrolling in a Dual Eligible Special Needs Plan (D-SNP) — or any health plan — can be a long and confusing process. “It does require a bit of research, paperwork and patience,” says Andy Friedell, chief operating officer of The Helper Bees, an aging-in-place platform in Austin, Texas.

Fortunately, there are some tried-and-true ways to make the whole process easier. Here’s a handy guide to help walk you through D-SNP enrollment. We want to help make it as simple as possible to get the benefits and services you need.

Step 1. Make sure you qualify

To become a D-SNP member, you need to be eligible for both Medicare and Medicaid, says Friedell. That’s where the “Dual” in D-SNP comes from.

How do you know if you qualify for both Medicare and Medicaid?

In general, you’re eligible for Medicare if you’re over age 65. You may be eligible earlier if you have a disability or certain conditions like end-stage renal disease.

If you’re already on both Medicare and Medicaid, then you automatically qualify for a D-SNP. All you need to do is provide proof of both your Medicare and Medicaid cards, says Michelle Katz, LPN, MSN, a health care advocate in the Washington, D.C. area.

Not on Medicaid and don’t know if you qualify for it? The rules for eligibility vary by state. One of the easiest ways to find out if you qualify is to talk to a licensed agent. You can speak with a licensed Aetna® agent for free by calling 1-833-771-3597 (TTY: 711). Agents are available:

8 AM to 8 PM, 7 days a week, October 1 to March 31
8 AM to 8 PM, Monday-Friday, April 1 to September 30

An Aetna agent can help you through the entire enrollment process for free.

Get the peace of mind of a 24/7 nurse line

Become an Aetna D-SNP member, and you can call our 24/7 Nurse Line to speak with a registered nurse, 24 hours a day, 7 days a week.

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Step 2. Research the available D-SNP options in your area

There are a lot of different D-SNPs out there. You’ll want to compare them based on cost, coverage and benefits, says Friedell. This can get confusing, so it’s another good time to get help from a licensed agent.

Another option: Check out the website of the health plan you’re interested in. For example, Aetna has a free online tool that makes it easy to search for and compare plans in your service area that may fit your needs. All you need is your ZIP code to get started.

Step 3. Make sure it’s the right time to enroll

Once you’ve picked your D-SNP, you’ll want to call the insurance company to start the enrollment process. The good news: You can do this at several different times throughout the year.*

Initial Enrollment Period. This is when you first become eligible for Medicare. It starts three months before your 65th birthday and continues for 7 months.

Annual Enrollment Period (AEP). The Annual Enrollment Period runs every year from October 15 to December 7. During this time, you can pick a new D-SNP (or any Medicare Advantage plan), switch from Original Medicare to Medicare Advantage or change your Part D coverage.

Special Enrollment Periods (SEPs). These are periods where you’re allowed to change health plans due to a qualifying life event, says Katz. Examples include if you move out of your current plan’s service area or move into a nursing home.

If you already have Medicaid benefits, or if you become newly eligible for them, you can enroll in a D-SNP during any SEP. There are three SEPs:

January 1 to March 31
April 1 to June 30
July 1 to Sept 30

Step 4. Complete the enrollment process

Ready to enroll? It’s time to contact your chosen plan’s insurance company, says Friedell. Once you do that, they can send you an enrollment form. They may ask to see a copy of your Medicaid card too, to verify that you’re eligible. If you’re enrolling in an Aetna D-SNP, our licensed agents can help you complete the entire process for free.

Enrolling in a health plan just got a lot easier
A licensed Aetna agent can help answer your questions and guide you through the enrollment process from start to finish — for free. Schedule a call with a licensed Aetna representative today — it can’t hurt to learn more.

Step 5. Review your coverage every year

It’s a good idea to review your D-SNP every year during the Annual Enrollment Period, says Katz. This way, you can make sure that all your doctors are still in the plan’s network, and that all your drugs are still covered. If you’re not happy with your plan, you can then switch. Just remember that it won’t go into effect until January 1 of the next year.

If you are eligible for both Medicare and Medicaid, you may be eligible for an Aetna® Dual Eligible Special Needs Plan (D-SNP).

Aetna® is a recipient of the Newsweek America’s Best Customer Service Award for 2023.*

* FOR FULL VERSUS PARTIAL MEDICAID BENEFITS: Medicare Interactive. “Enrolling in a SNP.” Accessed July 23, 2023. back

* FOR QUESTIONS TO ASK BEFORE YOU ENROLL: Medicare Interactive. “Questions to ask before enrolling in a D-SNP.” Accessed July 23, 2023. back

* FOR ENROLLMENT TIMING: Medicare.org. “When can I enroll in a DSNP?” Accessed July 23, 2023. back

* FOR ENROLLMENT TIMING: National Council on Aging. “What is a Dual Eligible Special Needs Plan?” November 30, 2022. Accessed July 23, 2023. back

*FOR NEWSWEEK AWARD: The 2023 Newsweek America’s Best Customer Service rankings were identified from the results of an independent survey of more than 30,000 U.S. customers who have either made purchases, used services, or gathered information about products or services in the past three years. Customers evaluated several brands: In total, over 200,000 evaluations were collected. The awarded brands each received on average 100 evaluations from customers. For more information, visit https://www.newsweek.com/rankings/americas-best-customer-service-2023.

Plan features and availability may vary by service area.

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FAQs

How to enroll in a Dual Eligible Special Needs Plan, or D-SNP? ›

Call #2 – Call 1-800-MEDICARE (1-800-633-4227) (TTY 1-877-486-2048) to enroll in Medicare Advantage (if applicable) or Medicare Part D (if applicable). Call #3 – Call NJ FamilyCare at 1-800-701-0710 (TTY 1-800-701-0720) to choose a new Medicaid Managed Care Organization (MCO).

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What are dual special needs plans d-snp quizlet? ›

What are Dual Special Needs Plans (D-SNP)? Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid.

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What are the enrollment periods for DSNP? ›

The Initial Enrollment Period (IEP)is a seven month period which begins three months prior to the month containing your 65th birthday. It includes the entire month of your birthday and continues for three months after that month.

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What are dual eligible SNPs? ›

Dual Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX).

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Does Meredith a D-SNP member lose Medicaid eligibility? ›

Meredith, a D-SNP member, loses Medicaid eligibility. What impact does this have on her D-SNP enrollment? - correct answers :She will enter a grace period during which she is responsible for plan cost sharing, and she will be disenrolled at the end of the grace period if she does not re-establish Medicaid eligibility.

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What are key characteristics of DSNP plans? ›

Generally speaking, D-SNPs include the following:

Care coordination.
$0 monthly premiums.
Over-the-counter quarterly benefits.
Dental, vision, and hearing benefits.
Transportation benefits.
Gym memberships.
Telehealth services.

What is the greatest challenge related to dual eligibles? ›

Separate eligibility requirements, benefits, and rules for Medicare and Medicaid sometimes contribute to what has been described as a “fragmented and disjointed system of care for dual eligibles” which may lead to difficulty in navigating care among dual-eligible individuals.

How many Americans are dual eligible? ›

In total, 12 million people are "dually eligible" and enrolled in both Medicaid and Medicare, composing more than 15% of all Medicaid enrollees. Individuals who are enrolled in both Medicaid and Medicare, by federal statute, can be covered for both optional and mandatory categories.

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What is the difference between Medicare and DSNP? ›

A Dual Eligible Special Needs Plan is one type of SNP. It's a managed care plan for people who qualify for both Medicare and state Medicaid assistance or Medicaid. A D-SNP combines multiple coverages and coordinates Medicare and Medicaid benefits to make them easy to access for people who have both.

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How does the loss of Medicaid affect a member's enrollment in a D-SNP? ›

Typically, if D-SNP members lose their Medicaid requirements, they are no longer also eligible for most DNPs. However, such individuals have the possibility to switch to another Medicare Advantage plan or return to Original Medicare during a SEP.

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Which consumer might benefit the most by enrolling in a DSNP? ›

The consumer who would benefit the most from enrolling in a d-snp is someone who qualifies for both programs and has complex healthcare needs. These individuals often have limited income and resources, and they typically require additional support services like care coordination and prescription drug coverage.

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What does DSNP mean? ›

A Dual Special Needs plan is a type of health insurance plan. It's for people who have both Medicaid and Medicare. If that's you, you're "dual-eligible." (That's just another way of saying you can have Medicaid and Medicare at the same time).

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What is the difference between D-SNP and C SNP? ›

Like a D-SNP, a Chronic Condition Special Needs Plan (C-SNP) is a type of SNP. While D-SNPs are for people with both Medicare and Medicaid eligibility, C-SNPs are designed for people who have a specific chronic or disabling condition (e.g., diabetes or heart disease).

Which of the following are the types of special needs plans SNPs? ›

There are three different types of SNPs:

Chronic Condition SNP (C-SNP)
Dual Eligible SNP (D-SNP)
Institutional SNP (I-SNP)

Sep 6, 2023

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What is true of our dual special needs plans? ›

Final answer: Dual special needs plans (D-SNPs) are designed for individuals who qualify for both Medicare and Medicaid, providing a more coordinated care experience. They're also affected by laws like the Mental Health Parity and Addiction Equity Act, facilitating better coverage for mental health services.

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