What is a Medicare DSNP?

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A Dual Eligible Special Needs Plan, or DSNP, is a unique type of Medicare Advantage plan that provides health benefits for people who are “dual eligible,” meaning they qualify for both Medicare and Medicaid.

Most individuals have heard of both Medicare and Medicaid. In short, Medicare provides health benefits for people over age 65 and people younger than 65 who qualify due to a disability. Medicaid provides health benefits to low income individuals, though eligibility criteria vary by state. 

About 30 percent of people eligible for Medicare have opted to get their Medicare benefits through what’s known as a Medicare Advantage plan which is a plan offered by a private health insurance company approved by the federal government. Medicare Advantage plans or MAPD for short, combine a person’s original Medicare benefits: including hospital (Part A) and doctor (Part B) coverage, and in many cases, Part D prescription drug coverage. Furthermore, they can offer additional benefits such as dental, vision and hearing coverage. 

Who qualifies for a Dual Eligible Special Needs Plan? 

Any individual who meets the eligibility criteria for both Medicare and Medicaid is qualified to enroll in a DSNP. Dual eligible beneficiaries often deal with special health needs that require additional assistance that improves their overall quality of life. 

For instance, they may:

  • Have a disability that either limits or prevents them from carrying out daily activities such as bathing and dressing.
  • Suffer from a cognitive or a mental disorder.
  • Receive care from multiple providers/doctors to manage multiple health conditions. 
  • Need in-home care providers or other health and social services. 
Dual Special Needs Plans (DSNP)
People who quality for a DSNP can enroll or switch to a new plan at any time during the year.

Why should someone consider a DSNP? 

While millions of Americans rely on both Medicare and Medicare for their health benefits, it can be tough to navigate through all the various benefits they provide. This is especially true for dual eligible beneficiaries. Dual Eligible Special Needs Plan can actually make it easier for these individuals to understand both the benefits and care they’ll receive being a member. Additionally, they help improve the members overall healthcare experience by encouraging all of the member’s physicians, care managers, hospitals, and specialists to to work together. 

Although coverage can vary by carrier, DSNPs usually offer additional benefits such as: 

  • Dental care, such as routine cleanings and exams, x-rays, fillings, crowns and extractions. 
  • Access to a health products catalogue to order discounted over-the-counter products such as vitamins, first-aid supplies, blood pressure monitors and more. 
  • Hearing exams and access to discounted hearing aids. 
  • Vision coverage. 
  • Transportation to health care visits and the pharmacy. 
  • Meal program 

Part D (prescription drug) coverage 

  • All Dual Eligible Special Needs Plans include Prescription Drug coverage
  • $0 monthly premiums. 
  • And more… 

When can people apply? 

People who quality for a DSNP can enroll or switch to a new plan at any time during the year, not just during the Open Enrollment Period or the Annual Election Period. Call your Dual Eligible Special Needs Plan experts at Bobby Brock insurance today! 

Justin Brock

Justin Brock

The CEO and President of Bobby Brock Insurance. A nationally syndicated Medicare advisor, best-selling author of Medicare Breakdown: The Alphabet Soup of Medicare, and pacesetter for over 20,000 senior market insurance agents. Featured in many insurance-related publications for his Medicare and Health insurance... Read More »

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