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Dual-Eligible Special Needs Plan: For People with Medicare & Medicaid

Are you confused about whether Medicare or Medicaid services will provide the right coverage options for your insurance needs? You don't have to choose — you can have both Medicare from the federal government and Medicaid benefits from the state to help you get the comprehensive healthcare coverage you need.

With a Medicare Advantage Dual-Eligible Special Needs Plan, you can have the best of both worlds. Here at Alignment Health Plan, we offer Dual Special Needs Plans (D-SNPs) to our clients who have both Medicare (from the United States government) and Medicaid (from their state government) eligibility.

Keep reading to find out precisely what a Dual Special Needs Plan is and how it can help you get the health care you need with the providers you want, at no extra cost to you.


What Is a Dual Special Needs Plan (D-SNP)?

A Medicare Dual Special Needs Plan (D-SNP), also referred to as a Medi-Medi or Duals plan, is a type of Medicare Advantage plan that offers extra benefits you usually wouldn't be able to get with just Medicaid services or just original Medicare.

One key feature of a Medicare Dual Special Needs Plan is that you must choose a primary care provider, who is essentially a care coordinator who handles all your medical care and any necessary specialist referrals.

Another great feature of enrolling in Medicare Dual Special Needs Plans is receiving the same coverage as Medicare Parts A and B, as well as Part D prescription drug coverage and all your Medicaid benefits, too. You may also get additional benefits on certain Dual Special Needs Plans, such as dental, vision, and even a gym membership.


Who Can Get Dual Special Needs Plans (D-SNPs)?

Medicare Advantage Dual-Eligible Special Needs Plans have specific eligibility requirements. For example, if you want to enroll in certain Medicare health plans, you need to meet specific criteria. This includes Medicare and Medicaid eligibility, a primary residence in the plan's service area, and Medicare Part A and Part B enrollment.


What Does a Dual Special Needs Plan Cover?

If your health plans don't have the features you need, then a Medicare Advantage Dual Special Needs Plan may be the solution. These plans provide some great coverage benefits, including:

  • Dental: Routine care with no copay
  • Prescription drugs: Home delivery of prescription medications with no copay
  • Healthy foods: Credits for nutritious foods at certain grocery stores
  • Health products: Credits for certain health products, including over-the-counter medications
  • Transportation assistance: No copays for rides to the pharmacy, urgent care, or doctor's office
  • Vision: No copay for routine exams and credits for glasses or contacts

The best part is that you get all these benefits with no extra out-of-pocket costs.


A Special Note About Enrolling in D-SNP Plans

It's important to remember that you can only qualify for these Medicare Advantage Special Needs Plans if you’re dually eligible for Medicare and Medicaid. Luckily, this means that you can enroll during the Annual Enrollment Period (AEP) from October 15th to December 7th each year and during what's called a “Special Enrollment Period.” This period allows you to enroll in a Dual-Eligible Special Needs Plan at any point during the year that you meet certain qualifying criteria, rather than just during the usual AEP.


Need More Information About Special Needs Plans? We Can Help.

If you need more information about Medicare plans, including Special Needs Plans, we can help. You can contact us here at Alignment Health Plan to learn more about how we can help you enroll in the right plan for your healthcare needs.

You can also visit the federal government website at, which is an excellent resource for more information. 


Frequently Asked Questions About Special Needs Plans


What Are Medicare Dual Special Needs Plans?

Medicare Advantage Dual Special Needs Plans, or D-SNPs, are a unique type of Medicare Advantage plan in which only dual-eligible members can enroll. That is, you can only enroll if you have eligibility for both Medicare and Medicaid. 

You’ll most likely need to choose a particular provider (your primary care doctor) who will coordinate all your care.


What Are the Advantages of a Dual Special Needs Plan?

The extra benefits of Special Needs Plans are numerous. To start, you can enroll in a Medicare Advantage plan that is customized to your exact care needs, so you can get low-cost or no-cost medical assistance whenever you need it.

Enrolling in Dual Special Needs Plans means you can keep all your Medicaid and Medicare benefits, and most routine or preventive services will be at no cost to you.


Who Qualifies for Medicare Dual Special Needs Plans?

There are specific eligibility requirements for Dual Special Needs Plans. For example, you may qualify if you have certain chronic conditions or live in an institutional setting (like a nursing home), but you must have dual eligibility for both Medicare and Medicaid.

You can apply past the annual enrollment period, but only if you meet certain requirements. Medicare calls this the Special Election Period, which is generally available year-round.


Final Thoughts

If you need help to determine which Medicare Advantage Plan is right for your needs, we can help. Here at Alignment Health Plan, we offer comprehensive Special Needs Plans that will fit your unique health care needs, no matter what kind of condition you have.

If you qualify for a D-SNP, we can help you enroll and get the benefits you need. We'll keep all your sensitive information safe, and we'll help you determine which plan fits your needs best. Contact us today at Alignment Health Plan and speak to one of our licensed insurance agents to find the right plan for you.

Click here for more frequently asked questions.