A Dual Eligible Special Needs plan provides special coverage for people who are eligible for both Medicare and Medicaid.
The plan is one of several Special Needs plans (SNPs), a type of Medicare Advantage (Part C) plan for people who qualify for state and federal public health insurance programs. Not all states offer the plans.
D-SNP is one of three types of special needs plans (SNPs), along with the Chronic Condition SNP (C-SNP) and Institutional SNP (I-SNP).
This article explains Dual Eligible Special Needs (D-SNPs) and discusses other SNPs. It also examines SNP eligibility, enrollment, and costs.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
According to Medicaid, 12 million people in the United States are eligible for Medicare and Medicaid coverage. This means they also qualify for a Dual Eligible Special Needs Plan (D-SNP).
SNPs provide tailored benefits, health provider lists, and prescription drug lists (formularies) to meet specific needs. They generally provide comprehensive coverage.
A D-SNP is a comprehensive plan available only to people who are eligible for both Medicare and Medicaid.
D-SNPs coordinate Medicare and Medicaid benefits to facilitate access for those with both. They also combine multiple coverages.
Each state decides which of the D-SNP benefits to offer and has the right to review them as they see necessary. States also set up their eligibility categories separately.
It is important for individuals to check with their state to see whether they qualify for a D-SNP.
Things to consider
Before choosing an SNP, a person might want to check on the services and benefits of each plan.
Factors to check may include:
- Is the individual eligible for any of the SNPs available in their area?
- How do SNP services compare with those offered through a person’s current plan?
- What benefits does the SNP provide that will assist with special health needs?
- Does the plan cover specialists?
- What are the costs for premiums, deductibles, and copays?
- Is there a yearly limit for out-of-pocket expenses?
- Can a person use their current doctor?
- Does the plan provide coverage for services from out-of-network providers?
- Does a person need a referral to see a specialist?
- Are a person’s prescription drugs listed on the plan formulary?
A person can call Medicare at 800-633-4227 or use this online tool to check for plans available in their area.
Learn more about Medicare Special Needs Plans.
To join a D-SNP, a person must be enrolled in Medicare and Medicaid.
A person can check if they are eligible for Medicaid through the Medicaid office in their state.
In general, a person can enroll in an SNP if they meet certain conditions:
- have Original Medicare (Part A and Part B)
- live in the plan’s service area
- have specific disabling or severe chronic conditions, including autoimmune disorders, end stage renal disease, or chronic lung disorders
It is important to remember that D-SNPs are required to contract with each state. However, the states are not required to contract with D-SNPs. Individuals should check whether these plans are available in their area.
Enrollment periods
A person can enroll in SNPs, including D-SNPs, during the following Medicare enrollment periods:
- Open Enrollment Period: October 15 to December 7
- Medicare Advantage Open Enrollment: January 1 to March 31 (for those with existing Medicare Advantage plans)
- Special Enrollment Period: Varies depending on certain situations, such as a change of address, getting Medicaid, or getting Extra Help
When a person has chosen a plan, they can call the plan provider for an online or paper enrollment form. They can also call Medicare for assistance at 800-MEDICARE (800-633-4227).
Learn more about Medicare enrollment periods.
Medicare SNPs must offer the same benefits as Original Medicare but may do so with separate rules, restrictions, and costs.
For example, an SNP may charge a monthly premium in addition to the monthly Part B premium. Each plan also specifies its copays, deductibles, and related cost-sharing for services.
According to the Centers for Medicaid & Medicare (CMS), the average monthly premium for Part C plans is around $17.00 in 2025. That said, if a person is enrolled in a D-SNP, most of the costs are covered by Medicare and Medicaid. A person does not generally have to pay a Medicare deductible or copay when they visit a health provider within the D-SNPs network.
Depending on the SNP, a person may also have coverage for out-of-network healthcare, although they may pay more for out-of-network services.
While SNPs cannot charge more than Original Medicare for specific types of care, including chemotherapy, dialysis, and skilled nursing facility care, additional costs may apply for other services, such as durable medical equipment, home health, and inpatient hospital care.
Some SNP providers may help a person get the correct information, benefits, and services through a care coordinator.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Special Needs plans (SNPs) are a type of Medicare Advantage plan, and include a Dual Eligible Special Needs plan (D-SNP). D-SNPs are available for individuals who qualify for both Medicare and Medicaid.
A person can join an SNP if they have Medicare Part A and Part B, live in the plan service area, and have one or more of the covered chronic health conditions.
Coverage is comprehensive, although costs may vary between SNP plans, including in a D-SNP.