PharmSurance Field Guide
What Is a D-SNP?
A Complete Guide
If you have both Medicare and Medicaid, you may qualify for a specialized plan that coordinates both programs into one integrated plan.

Being "dual eligible" — qualifying for both Medicare and Medicaid — gives you access to a powerful type of plan most people don't know exists. Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage plans specifically designed for people in exactly your situation.

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What Is a D-SNP?
Dual Special Needs Plan
The simple version

A D-SNP is a Medicare Advantage plan built specifically for people who have both Medicare and Medicaid. It coordinates both programs into one card, one plan.

What makes D-SNPs different
  • Designed to integrate Medicare and Medicaid benefits
  • Often include a dedicated care coordinator to help manage your health
  • Cost structure is built with dual-eligible members specifically in mind
  • May include coverage not in standard Medicare Advantage plans
  • Only available in certain counties — availability varies by location
  • Must meet eligibility requirements for both Medicare and Medicaid
How D-SNPs Are Different
What sets these plans apart
Beyond standard Medicare

D-SNP plans are structured specifically around the needs of people who qualify for both Medicare and Medicaid.

What makes a D-SNP different
  • Cost structure designed around dual-eligible members (you still pay Part B if not covered by Medicaid)
  • May include coverage not found in standard Medicare Advantage plans
  • Dedicated care coordinator to help manage your health
  • One plan, one card, coordinated across both Medicare and Medicaid
  • What's included varies significantly by plan and county — a PharmSurance advisor can walk through what's actually available where you live
Enrollment Flexibility
You don't have to wait for October
A major advantage for dual-eligible individuals

Many fully dual-eligible individuals can switch to a D-SNP plan any month of the yearnot just during the October enrollment window.

The monthly Special Enrollment Period
  • Full dual-eligible individuals have a monthly SEP to switch to an integrated D-SNP
  • This means if you qualify today, you don't have to wait months for AEP
  • Eligibility for this SEP depends on your specific dual-eligible status
  • Partial dual-eligible individuals may have more limited SEP options
How to qualify
Who is eligible for a D-SNP?
Basic eligibility requirements

You must be enrolled in Medicare (Parts A and B) and also qualify for Medicaid in your state. This includes full dual eligible individuals as well as those who qualify for a Medicare Savings Program (QMB, SLMB, or QI).

How to find out if a D-SNP is available in your area

D-SNP availability varies by county. A PharmSurance advisor can check what's available in your specific location and whether you qualify for the monthly enrollment period.

Think you might qualify for a D-SNP?

A PharmSurance advisor can check your eligibility, find available D-SNP plans in your area, and walk you through the enrollment process. At no cost to you.

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