All You Need to Know About Dual Eligible Special Needs Plans

By Brian Krantz - January 31, 2023

If you are eligible for both Medicare and Medicaid in New York, you are entitled to enroll in a Dual Eligible Special Needs Plan (or a D-SNP for short). The New York Medicare advisors at Plan Medicare will help you learn about and enroll in a Dual Eligible Special Needs Plan. Here is some basic information on this unique plan.

What is a Dual Eligible Special Needs Plan?

A D-SNP is a Medicare Advantage plan that leverages both Medicare and Medicaid, offering affordable coverage for qualifying individuals, with an array of added benefits.  Dual Eligible Special Needs Plans are required to offer everything that traditional Medicare covers and a lot more including coordinated care teams, social workers, care managers, nurse care managers and more. The goal of this plan is to ensure that all of your benefits are working together, and you are able to maximize your Medicare and Medicaid coverage equally.

In New York, individuals who are eligible for this unique plan are able to enjoy a suite of benefits including (but not limited to):

  • Prescription drug coverage
  • Dental, vision, and hearing benefits
  • $0 monthly premiums
  • Over-the-counter quarterly benefits
  • Select transportation benefits
  • Gym memberships
  • Telehealth services

Who is Eligible for D-SNPs?

In order to qualify for a Dual Eligible Special Needs Plan, you must first qualify for both Medicare and Medicaid.

In New York, you can qualify for Medicare coverage if you are 65 years or older or meet one of the alternative qualifying circumstances, like receiving 25 months of Social Security Disability Insurance (SSDI) or having ALS or End-Stage Renal Disease.

In New York, in order to qualify for Medicaid, you must have a maximum income of $2,523 per month if you are single, or $5,046 if you are a married couple.

Because the requirements for eligibility for a D-SNP are nuanced and vary from state to state, it is important to meet with a local Medicare Advisor who can walk you through the various options.

Enrolling in a D-SNP

The enrollment window for enrolling in a D-SNP is the same as the window for any Medicare Advantage Plan. You can enroll during Open Enrollment Period (Oct 15-Dec 7th) or the Medicare Advantage Open Enrollment Period (MA OEP). You are also granted a Special Enrollment Period (SEP) when you become dual eligible or eligible for both Medicare and Medicaid. So if you are newly eligible, it’s important to speak with a local New York Medicare Advisor to take advantage of a SEP that applies to your unique situation.

Also, dual eligible beneficiaries are able to enroll, unenroll, or switch D-SNPSs once per each of the first three calendar quarters. This provides plenty of opportunities to figure out which plan would fit your needs the best.

The team of local New York Medicare advisors at Plan Medicare are available to walk you through the entire enrollment process. If you or someone you know qualifies for a Dual Eligible Special Needs Plan, call our team to learn more about taking advantage of all that a D-SNP has to offer. Call 516-900-7877 or contact us now


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