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If you’re 65 or older and have a low income, managing health care can feel tough. Luckily, there are special plans for people who qualify for both Medicare and Medicaid. These plans are called Dual-Eligible Special Needs Plans, or D-SNPs. They can lower or even eliminate your costs and give you extra benefits.

Oct. 27, 2025

A D-SNP is a type of Medicare Advantage plan. This means you get it from a private insurance company. It’s made for people who qualify for both Medicare and some form of Medicaid.

One benefit of a D-SNP is that you get care coordination services. These services help Medicare and Medicaid work together to meet your needs.1

Since a D-SNP is a Medicare Advantage plan, it might offer extra benefits that Original Medicare doesn’t, like dental, vision, and hearing coverage.

Your D-SNP plan may be a zero-dollar cost-sharing plan, meaning you pay nothing out of pocket when you get medical care.2

How to qualify for a Dual-Eligible Special Needs Plan

In order to get a D-SNP, you need to be eligible for both Medicare and your state’s Medicaid program. You also must live in the plan’s service area.

There are several ways to qualify for Medicaid, which can let you join a D-SNP. You might be eligible for this option even if you don’t qualify for full Medicaid.

Qualifying for Medicare

To qualify for Medicare, you generally need to be 65 or older. You can also qualify if you have been receiving Social Security Disability benefits for 24 months or have specific health conditions, such as amyotrophic lateral sclerosis (ALS).3

Original Medicare has two parts: Part A for hospital care and Part B for other medical care. You need both parts to join a D-SNP.1

Qualifying for Medicaid

Medicaid rules are different in each state. It’s important to check with your local Medicaid office to see if you qualify and to find out your eligibility.

  • Full Medicaid: You might qualify for full Medicaid if you meet your state’s usual rules. These rules usually include having a low income, being 65 or older, or having a disability, as stated by Social Security.4
  • Qualified Medicare Beneficiary (QMB): If you can get Medicare Part A, have income at or below 100% of the federal poverty level, and have assets of $9,660 or less for one person or $14,470 or less for a couple (in 2025), you can qualify for a D-SNP as a Qualified Medicare Beneficiary.5
  • Specified Low-Income Medicare Beneficiary (SLMB): You can qualify for a dual-eligible plan as an SLMB if your income is at or below 120% of the federal poverty level and your assets are at or below $9,660 for an individual or $14,470 for a couple (for 2025).5
  • Qualifying Individual (QI): To be a Qualifying Individual, your monthly income must be 135% or less of the federal poverty level, and your assets must be $9,660 or less for one person or $14,470 or less for a couple (in 2025).5
  • Qualified Disabled Working Individual (QDWI): To get a D-SNP in this category, you must have a disability, be working, and have lost your Social Security Disability payments because you are working. Your income can be at or below 200% of the federal poverty level, and your assets must be at or below $4,000 for an individual and $6,000 for a couple (for 2025).5

The Medicaid category you qualify for can affect how much your state’s Medicaid program pays for your medical care. Make sure you understand all the details of the S-DNP you join, including monthly premiums, deductibles, and any out-of-pocket costs.

How is a Dual-Eligible Special Needs Plan different from regular Medicare?

The first thing that makes a D-SNP plan different is that it’s a Medicare Advantage plan, not Original Medicare. This means you might get extra benefits like dental and vision coverage.6

You may also be eligible for discounts on fitness programs, over-the-counter medications, and other services.6 An Advantage plan also covers everything Original Medicare covers, such as prescription drugs and annual wellness visits.

Like other Medicare Advantage plans, you need to stay in the provider network to keep costs low. Some plans cover you outside the network, but most only let you see providers on their list unless it’s an emergency.

A D-SNP compared to other Medicare Advantage plans

A D-SNP is a special type of Medicare Advantage plan made for lower-income seniors and people with disabilities.

When you have a D-SNP, your Medicare coverage through the plan is the main coverage for your health care. Your Medicaid plan covers some or all of the other costs.

For example, your Medicaid plan might pay for your Medicare Part B premiums, deductible, and any copays or other costs you usually have with your Medicare Advantage plan.

A D-SNP can also offer extra benefits. Care coordination is the primary focus of this type of plan, but you might get additional services or benefits that are good for low-income seniors.6

When to enroll in a D-SNP

You must have Original Medicare in order to enroll in a D-SNP, but that doesn’t mean you have to wait. You can enroll in a D-SNP within three months of when you get Medicare since it’s an Advantage plan.7

You can also enroll in a D-SNP during other regular enrollment periods as well. This includes:

  • Open Enrollment: Between October 15 and December 31 of each year.
  • Medicare Advantage Open Enrollment: January 1 to March 31 of each year.

Another time you can choose a D-SNP plan is during a special enrollment period (SEP). You get a SEP when your life changes. This could include moving to a new area, going in or out of a nursing home, or becoming newly eligible for Medicaid in along with Medicare.8

Special enrollment periods can be different lengths, so make sure you understand the details of the SEP that applies to you.

Starting in 2025, two new monthly SEPs are available for people who are eligible for both Medicare and Medicaid. One lets you switch to Original Medicare with a separate prescription drug plan or switch between different drug plans.9

The other allows those who qualify for their state’s full Medicaid program to switch into an integrated plan in order to align their benefits between Medicare and a Medicaid Managed Care Organization.9

How to enroll in a Dual-Eligible Special Needs Plan

To enroll in a D-SNP, you can go online or work with an insurance agent. If you work with an agent, make sure they follow the specific rules that apply to Medicare beneficiaries.7

The Medicare website features an online plan finder that enables you to determine which D-SNPs are available in your area. You can also find a list in the back of your “Medicare & You” handbook for the current year.7

Once you have chosen a plan, you can complete the application online or contact the company directly through their website or by phone. You can also enroll by calling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.7

Other types of Special Needs Plans

A D-SNP is a Special Needs Plan for low-income seniors. There are other Special Needs Plans that focus on different health issues or specific needs.

Chronic Special Needs Plans (C-SNP)

A C-SNP is a Medicare Advantage plan that’s tailored to help you get the care you need for specific chronic conditions. The Centers for Medicare & Medicaid Services (CMS) lists 15 chronic conditions that a C-SNP can cover.10

Insurers can tailor the C-SNP to one specific condition or to a group of conditions that often occur together.10 For example, a plan may only cover cancer or only HIV/AIDS. Or, a plan could cover both chronic heart failure and cardiovascular disorders and have specialized cardiologists in network.

To qualify for a C-SNP, you must have at least one of the chronic conditions the plan covers. The plan might give you access to specific prescription drugs for your condition, lower the costs of these drugs, provide extra hospital days, or offer other benefits in addition to regular Medicare Advantage coverage.1

Institutional Special Needs Plans (I-SNPs)

An I-SNP is a Medicare Advantage plan made for people who need or are expected to need specific types of inpatient care for 90 days or longer. This includes long-term care, skilled nursing care, intermediate care for intellectual disabilities, and inpatient psychiatric care.11

This care usually happens at an approved place, but sometimes it can also cover people who live in the community.11

Let WellMed help you take care of your health today

At WellMed, we understand the needs of seniors. In fact, we’re proud to offer age-friendly doctors and specific support for older patients.

Whether you have a chronic health condition or simply need a checkup, we can provide the care you need. We accept Original Medicare and Medicare Advantage plans. Contact one of our clinics to learn more!

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