Dual Special Needs Plans

Dual Special Needs Plans (D-SNPs) provide great affordable healthcare coverage to those who qualify for both Medicare and Medicaid, meaning that they are part of the dual-eligible population.

To fully understand what D-SNPs are and how they work, you have to consider your Medicare eligibility, and your Medicaid status as well as have the appropriate knowledge of Medicare Advantage.

Medicare Eligibility

Because D-SNPs are only available to those who qualify for both Medicare and Medicaid, you must consider your Medicare eligibility first.

You must be enrolled in both Medicare Part A and Part B. The requirements for both plans are the same—you must meet at least one of these requirements:

  • Be 65 Years Old or Older
  • Have End-Stage Renal Disease (ESRD), Lou Gehrig’s Disease, or ALS
  • Have Received Social Security Disability Benefits for at Least 24 Months


Medicare Part A provides hospital coverage. To a certain limit, your medical expenses for short-term hospital and nursing facility/home care. Part B, on the other hand, covers general medical expenses.

This includes benefits such as preventative care, ambulance services, diabetes supplies, durable medical equipment (DME), and more. In general, Part A is free for most individuals whereas Part B implies the monthly deductible individuals have to pay.

The total 2023 Part B deductible is $226, and the monthly premium is $164.90. Usually, new beneficiaries purchase Part A and Part B together.


Medicaid eligibility is based on financial need, specifically your Modified Adjusted Gross Income (MAGI). You are, however, exempt from most major monetary considerations if you have a serious disability (including blindness) and if you are 65 years old or older.

In case you fall under any of these two categories, your Medicaid eligibility is based on Supplemental Security Income (SSI) rather than MAGI.

If you receive Medicaid benefits and meet the Medicare requirements, you will most likely be eligible for a D-SNP whose eligibility can be grouped into these categories. You qualify If you:

  • Are receiving Full Medicaid benefits
  • Are a Qualified Medicare Beneficiary (QMB) without other Medicaid (QMB Only)
  • Receive QMB Plus
  • Are a specified Low-Income Medicare Beneficiary (SLMB) without other Medicaid (SLMB Only)
  • Receive SLMB Plus
  • Are a Qualifying Individual (QI)
  • Are a Qualified Disabled and Working Individual (QDWI)


These terms are very confusing to the average person. The easiest way to determine if you are eligible for a D-SNP, then, is to contact your local Social Security office and ask if you fall within one of these qualifications.

When considering your D-SNP eligibility, then, you must consider your age/health, and your SSI.

Advantage and

D-SNPs fall under the category of Medicare Advantage. All Advantage plans, D-SNPs included, offer all of the previously mentioned benefits of Original Medicare, as well as the coordinated healthcare services of Advantage plans to lower your out-of-pocket costs.

Because D-SNPs are more specialized than the average Advantage plan, they offer eligible individuals additional benefits, such as:

  • Health Care Coordination/Care Coordinator
  • Routine dental care
  • Vision and hearing benefits
  • Over-the-counter quarterly benefits
  • Transportation benefits
  • Telehealth services
  • Gym memberships
  • Part D or Prescription Drug Coverage

Five Common



and how you can avoid them

Five Common Medicare Mistakes Book Cover

Still unsure if you qualify for a D-SNP? Do you qualify but need help enrolling in a plan? That’s why we’re here. Texas Medicare Advisors helps people just like you navigate and take control of their Medicare coverage. If you would like a consultation, give us a call today at 512-900-3008.

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