--- title: Dual Special Needs Plans (D-SNP) FAQ description: Learn all about Dual Special Needs Plans (DSNPs) for Medicare and Medicaid beneficiaries, including eligibility, benefits, and enrollment information. image: https://blog.agentpipeline.com/hubfs/DSNP%20FAQs.png --- [![Agent Pipeline Logo - 01 Full Color-2](https://blog.agentpipeline.com/hs-fs/hubfs/Agent%20Pipeline%20Logo%20-%2001%20Full%20Color-2.png?width=100&name=Agent%20Pipeline%20Logo%20-%2001%20Full%20Color-2.png "Agent Pipeline Logo - 01 Full Color-2")](https://blog.agentpipeline.com/?hsLang=en) Search toggle [Follow us on Facebook](https://www.agentpipeline.com) [Follow us on Facebook](mailto:info@agentpipeline.com) [Follow us on Facebook](https://www.facebook.com) [Follow us on Facebook](https://www.linkedin.com/company/agentpipeline) [Follow us on Instagram](https://www.instagram.com) [Follow us on Twitter](https://www.youtube.com) [![Agent Pipeline Logo - 01 Full Color-2](https://blog.agentpipeline.com/hs-fs/hubfs/Agent%20Pipeline%20Logo%20-%2001%20Full%20Color-2.png?width=100&name=Agent%20Pipeline%20Logo%20-%2001%20Full%20Color-2.png "Agent Pipeline Logo - 01 Full Color-2")](https://blog.agentpipeline.com/?hsLang=en) Search toggle [![Agent Pipeline Logo - 01 Full Color-1](https://blog.agentpipeline.com/hs-fs/hubfs/Agent%20Pipeline%20Logo%20-%2001%20Full%20Color-1.png?width=300&name=Agent%20Pipeline%20Logo%20-%2001%20Full%20Color-1.png "Agent Pipeline Logo - 01 Full Color-1")](https://blog.agentpipeline.com/?hsLang=en) [Follow us on Facebook](https://www.agentpipeline.com) [Follow us on Facebook](mailto:info@agentpipeline.com) [Follow us on Facebook](https://www.facebook.com) [Follow us on Facebook](https://www.linkedin.com/company/agentpipeline) [Follow us on Instagram](https://www.instagram.com) [Follow us on Twitter](https://www.youtube.com) Search What are you looking for? Search # Dual Special Needs Plans (D-SNP) FAQ 29 Feb 2024 ![Picture of Jessica Adkins](https://blog.agentpipeline.com/hs-fs/hubfs/headshot2.jpg?width=40&name=headshot2.jpg) [Jessica Adkins](https://blog.agentpipeline.com/blog/author/jessica-adkins) ![](https://blog.agentpipeline.com/hubfs/DSNP%20FAQs.png) Dual Special Needs Plans (DSNPs) are a type of Medicare Advantage health plan designed for consumers with both Medicare and Medicaid and categorized as a Full Dual Eligible under the [Medicare Savings Program](https://www.medicare.gov/basics/costs/help/medicare-savings-programs). These individuals receive Medical benefits through Medicaid and additionally receive assistance in paying Medicare premiums, deductibles, and coinsurance. [12.9 million people](https://www.kff.org/other/state-indicator/number-of-medicare-medicaid-enrollees-based-on-medicare-claims-data/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D) received health coverage under both Medicare and Medicaid in 2021, and [according to KFF.org, in 2023, 5.2 million dual-eligible](https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2023-enrollment-update-and-key-trends/) individuals were enrolled in a Medicare Advantage plan designed specifically for dual-eligible individuals. DSNPs are required to provide greater coordination of Medicare and Medicaid benefits than other Medicare Advantage plans to improve coordination across programs and patient outcomes. DSNPs typically provide benefits not otherwise available in traditional Medicare and generally do not charge a premium.  ### Who is a candidate for a DSNP? Consumers who have both Medicare and Medicaid and who are categorized as Full Dual Eligible under the Medicare Savings Program. These individuals receive Medical benefits through Medicaid and additionally receive assistance in paying Medicare premiums, deductibles and coinsurances. The Full Dual Eligible categories include: - FBDE: Full Benefit Dual Eligible – these individuals only have Medicaid benefits and will be responsible for the cost sharing for Part A & B services (deductibles, copays, and coinsurance) - QMB+: Qualified Medicare Beneficiary Plus Full Medicaid benefits - SLMB+: Specified Low-Income Medicare Beneficiary Plus Full Medicaid benefit The Partial Dual Eligible categories include: - SLMB: Specified Low-Income Medicare Beneficiary - QDWI: Qualified Disabled and Working Individual - QI: Qualifying Individual ### What are the eligibility requirements to enroll in a DSNP? To be eligible for a DSNP the consumer must be: - Entitled to Medicare Part A - Enrolled in Medicare Part B - United States citizen or lawfully present in the United States - Receive state Medicaid benefits also known as Medicare Savings Program (qualifying Medicaid category) - Reside in the plan’s Service Area ### What are different dual eligibility levels/categories? Medicare consumers may get help from their state to pay for their Medicare premiums. These programs are also known as Medicare Savings Programs. In some cases, the Medicare Savings Programs may also pay for Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) deductibles, coinsurance, and copayments if they meet certain conditions set by the state. Below are the lists of Medicare Savings Programs that may be available in a state. *Note: Medicaid eligibility levels and qualifying requirements varies by state.* *![DSNP FAQ Chart](https://blog.agentpipeline.com/hs-fs/hubfs/DSNP%20FAQ%20Chart.png?width=2240&height=1260&name=DSNP%20FAQ%20Chart.png)* ### How do I know if a person has full dual eligibility? To determine what level of benefit the consumer has (Medicare Savings Program) you can review the consumer’s state “[Award Letter](https://www.ssa.gov/forms/ssa-l447.pdf),” contact the state Medicaid office, or look at the consumer’s Medicaid card. ### What are common SEPs for dual-eligible consumers? SEP-DUAL/LIS (MAINTAINING SEP) Dual eligible or Low Income Subsidy (LIS) eligible consumers who are maintaining their status have a quarterly (not monthly) opportunity to change plans within the first nine months of the calendar year. SEP-DUAL/LIS (CHANGE IN STATUS) Dual eligible or LIS eligible consumers who had a change in either their Medicaid Assistance (Medicare Savings Program) or LIS/Extra Help level or lost the assistance, will have the opportunity to change plans within 3 months of their notification of change or from when the change went into effect, whichever is later. ### How does a consumer know if there has been a change in their level of assistance? A consumer will receive a “Notification Letter” from CMS or their state when their LIS or Medicare Savings Program level changes. The letter indicates the effective date of the change. ### What happens if a DSNP member loses their Medicaid eligibility for the plan? f a D-SNP member loses Medicaid eligibility for the plan, the member can remain enrolled in the DSNP for a period of continued eligibility, which is often called the “grace period.” The grace period can vary in length from 1 to 6 months but is generally 6 months for most DSNPs. Additionally, a Special Election Period (SEP) (DUAL LIS (change in status) is available for DSNP members who lose Medicaid eligibility. This SEP begins the month the member is notified by the plan of the loss of Medicaid eligibility and ends when they enroll into a different Medicare Advantage Part D plan or 3 months after they have been disenrolled from the DSNP, whichever is earlier. *Note: DSNP members in a grace period due to the loss of Medicaid eligibility (e.g., Medicare Savings Programs) are responsible for paying their Medicare Part A and B cost sharing.* ### How can a Medicaid-eligible consumer recertify for Medicaid? Medicaid recipients can recertify as early as 90 days from termination – which is generally preferred, but in most states, the opportunity is allowed 60 and 30 days from termination as well. If the Medicaid recipient DOES NOT recertify in time, depending on the state, there may be a lapse of time, up to 90 days from the date of termination, to comply. This does not necessarily mean they will be reinstated if they comply. They must still meet all conditions of eligibility. ### How do I get started helping dual eligibles? Check with your Agent Pipeline consultant to ensure you're appointed, certified, and ready to sell with insurance companies offering DSNP plans in your service areas. You can also leverage our Medicaid Resource Center on the [MARC](http://www.myagenresourcecenter.com) for additional resources, including contacts to your state Medicaid offices and community organizations who may be able to assist your Medicaid-eligible clients further.   ### Share: [Share on Facebook](http://www.facebook.com/share.php?u=https://blog.agentpipeline.com/blog/dual-special-needs-plans-d-snp-faq&utm_medium=social&utm_source=facebook) [Share on LinkedIn](http://www.linkedin.com/shareArticle?mini=true&url=https://blog.agentpipeline.com/blog/dual-special-needs-plans-d-snp-faq&utm_medium=social&utm_source=linkedin) [Share on X](https://twitter.com/intent/tweet?original_referer=https://blog.agentpipeline.com/blog/dual-special-needs-plans-d-snp-faq&utm_medium=social&utm_source=twitter&url=https://blog.agentpipeline.com/blog/dual-special-needs-plans-d-snp-faq&utm_medium=social&utm_source=twitter&source=tweetbutton&text=Dual%20Special%20Needs%20Plans%20(D-SNP)%20FAQ) [Compliance](https://blog.agentpipeline.com/blog/tag/compliance), [Medicare](https://blog.agentpipeline.com/blog/tag/medicare), [Dual Eligibles](https://blog.agentpipeline.com/blog/tag/dual-eligibles) ## Jessica Adkins Jessica Adkins is Agent Pipeline's Senior Vice President of Sales Enablement. [marketing@agentpipeline.com](mailto:marketing@agentpipeline.com) [Follow me on my website](http://www.agentpipeline.com) [Follow me on LinkedIn](https://www.linkedin.com/in/jessica-lee-adkins/) ## Comments ## Related posts Search [Compliant Events 101: A Guide to Event Types](https://blog.agentpipeline.com/blog/compliant-events-101-a-guide-to-event-types?hsLang=en) [Follow us on Facebook](https://www.facebook.com) [Follow us on X](https://www.x.com) [Follow us on Instagram](https://www.instagram.com) Follow Agent Pipeline on social media! ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "author" : { "@type" : "Person", "name" : "Jessica Adkins", "url" : "https://blog.agentpipeline.com/blog/author/jessica-adkins" }, "dateModified" : "2024-02-29T15:31:25.671Z", "datePublished" : "2024-02-29T15:25:49.000Z", "headline" : "Dual Special Needs Plans (D-SNP) FAQ", "image" : [ "https://blog.agentpipeline.com/hubfs/DSNP%20FAQs.png" ], "mainEntityOfPage" : { "@id" : "https://blog.agentpipeline.com/blog/dual-special-needs-plans-d-snp-faq", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://blog.agentpipeline.com/hubfs/Agent%20Pipeline%20-%20Logo%201500x500.png" }, "name" : "Agent Pipeline" } } ```