Dual Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage Special Needs Plans for people who qualify for both Medicare and Medicaid. In this article, we’ll explore D-SNPs, including eligibility, benefits, and how to enroll.
Your eligibility can depend on state rules and your Medicaid category, so the right plan isn’t always obvious. Our licensed Medicare Advisors can review your situation and confirm which D-SNPs you qualify for. We’ll also help compare available Medicare plans and identify the one that best fits your needs.
Key takeaways
D-SNPs coordinate your Medicare and Medicaid benefits and often lower or eliminate your out-of-pocket costs.
Rules vary by state, and your Medicaid category affects eligibility and the benefits you get.
You can enroll in a D-SNP when you first become eligible and during specific windows after that.
What is a D-SNP?
A D-SNP is a type of Medicare Advantage Special Needs Plan (SNP) for people who qualify for both Medicare and Medicaid. It’s based on program status, which is different from the other types of Medicare SNP plans:
Chronic condition SNPs (C-SNPs): For people with chronic health conditions
Institutional SNPs (I-SNPs): For people in institutions or who need a similar level of care
D-SNPs had 5.8 million enrollees in 2024, up from 2.2 million in 2018. They cover the same Medicare Part A and Part B benefits as other Medicare Advantage plans, but they’re tailored to the needs of people who also receive Medicaid. For example, you often get extra benefits like a care coordinator and help with transportation or groceries. The details vary depending on where you live and which plan you choose.
Who is eligible for D-SNPs?
To be eligible for D-SNPs, you must qualify for both Medicare and Medicaid. You also need to:
Have Medicare Part A and Part B: Like all Medicare Advantage plans, D-SNPs require active enrollment in Medicare Part B and Part A.
Qualify for Medicaid through your state: Medicaid eligibility rules vary by state, so check with your state Medicaid office to find out if you qualify.
Live in the D-SNP’s service area: Plans have local coverage areas, so your home address affects which plans you’re eligible for.
Meet the plan’s specific eligibility requirements: Check to see if you meet the plan’s conditions for acceptance. Some require you to be “full dual eligible,” meaning you get full Medicaid benefits. Others are available to people who receive more limited help, like assistance with Medicare premiums.
Although these are the general rules, plan availability and eligibility rules vary by state, county, carrier, and plan. It’s important to confirm details with local providers and your state health insurance department.
What benefits do D-SNPs offer?
D-SNPs coordinate Medicare and Medicaid benefits, which help reduce out-of-pocket costs. All Medicare SNPs are required to offer prescription drug coverage. Other common benefits include:
99% of plans cover eye exams and/or eyeglasses.
98% cover hearing exams and/or aids.
98% offer dental coverage.
93% offer fitness benefits.
66% include over-the-counter benefits.
57% include meal benefits.
48% cover remote access technologies.
34% cover acupuncture.
32% offer Medicare Part B rebates.
24% cover transportation.
The percentages come from a Kaiser Family Foundation analysis of SNPs overall, but KFF data also shows that D-SNPs account for 82% of these Special Needs Plans.
Over-the-counter benefits often come through an OTC or “flex” card. Some people with chronic conditions may qualify for a separate set of benefits called Special Supplemental Benefit for the Chronically Ill (SSBCI). Plans often deliver SSBCI funds through the same card, and these benefits can include grocery allowances and support with utilities. SSBCI has its own health-based eligibility requirements.
The exact benefits you can receive depend on factors, such as Medicaid status, state rules, and plan design. Review each plan’s Summary of Benefits and check its provider network, drug formulary, and Medicaid coordination details before you enroll.
How do D-SNPs work with Medicare and Medicaid?
Here’s a summary of how Medicare and Medicaid plans compare with D-SNPs:
| Program | What it may cover | What to check |
|---|---|---|
| Medicare | Hospital treatment (Part A) and outpatient care (Part B), plus prescription drug coverage if you add a Part D plan. | Verify out-of-pocket costs, which can be high for Original Medicare, with 20% coinsurance for most Part B services. |
| Medicaid | Hospital treatment, outpatient care, long-term care, and often prescriptions, dental, vision, hearing, and other benefits. | Unlike Medicare, Medicaid is run by states, not the federal government. Coverage and eligibility vary between states. |
| D-SNP | Combines Medicaid and Medicare coverage with little-to-no out-of-pocket costs. May offer other benefits like transportation and care coordination. | Unlike Original Medicare, people on a D-SNP can only see providers in the plan’s network. Check the plan to see if your doctors and hospitals are covered. |
How do you enroll in a D-SNP?
Enrolling in a D-SNP is a straightforward process:
Find a plan: Use Medicare’s plan comparison tool to compare plans in your area and find one that’s right for you. You can also work with a Medicare agent.
Choose when to enroll: Make sure you’re in an enrollment period (see below).
Submit your application: Enroll through the Medicare website, by calling 1-800-MEDICARE, or by contacting the plan provider directly.
Here’s when you can enroll in a D-SNP:
Initial Enrollment Period: This window starts three months before you turn 65 and ends three months after. If you enroll in advance, your coverage begins the first day of the month you turn 65. If you enroll later, it starts the first of the month after the plan gets your request.
Open Enrollment Period: Every year from October 15 to December 7, you can join, drop, or switch to a D-SNP or another Medicare plan. Coverage starts on January 1 of the next year.
Medicare Advantage Open Enrollment Period: If you’re already on a Medicare Advantage plan, you can switch to a new one from January 1 to March 31. Coverage starts on the first day of the month after you apply.
Special Enrollment Period: This window opens when individual circumstances occur, such as moving or losing coverage. Eligible reasons are listed on the Medicare website. People with full Medicaid benefits can usually join or switch to a D-SNP once per calendar month.
Get help comparing D-SNPs
D-SNPs coordinate your Medicare and Medicaid coverage and reduce (or even eliminate) out-of-pocket healthcare costs. But it can be difficult to figure out your eligibility and understand which plan offers the best benefits for you. Different networks, cost-sharing rules, and coverage details can make the process confusing.
Chapter’s licensed, independent Medicare Advisors can help you understand the options available. Get free, personalized support to compare plans based on your specific needs, including your:
Doctors
Prescriptions
Average healthcare costs
Medicaid status
Healthcare needs
Call us today at 855-900-2427 or book a free consultation.
Sources
Medicare (2026). Dual Eligible Special Needs Plans (D-SNPs). https://www.cms.gov/medicare/enrollment-renewal/special-needs-plans/dual-eligible
Kaiser Family Foundation (2025). A Closer Look at the Growing Role of Special Needs Plans in Medicare Advantage. https://www.kff.org/medicare/a-closer-look-at-the-growing-role-of-special-needs-plans-in-medicare-advantage/
Kaiser Family Foundation (2025). Medicare Advantage 2026 Spotlight: A First Look at Plan Premiums and Benefits. https://www.kff.org/medicare/medicare-advantage-2026-spotlight-a-first-look-at-plan-premiums-and-benefits/
Medicare (2026). Joining a plan. https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan
Medicare (2026). Special Enrollment Periods. https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan/special-enrollment-periods
