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Dual Special Needs plans (D-SNP) frequently asked questions (FAQs)
Looking for information about Dual Special Needs plans (D-SNP)? We're here to help. Find answers to common questions about Dual Special Needs plans (D-SNP) — from who is eligible to how to apply and more.
What is a Dual Special Needs Plan (D-SNP)?
A Dual Special Needs plan is a type of health insurance plan. It’s for people who have both Medicaid and Medicare. If that’s you, you're "dual-eligible." (That's just another way of saying you can have Medicaid and Medicare at the same time).
What's the difference between Medicare and Medicaid?
Medicare is a national health insurance program run by the federal government. It’s for people age 65 and older, and also some people under age 65 with certain disabilities. Medicaid is a joint program that states and the federal government fund together. Millions of people get health coverage through their state Medicaid program. Children, pregnant women, elderly adults and people with disabilities, as well as eligible low-income adults are typically covered by Medicaid.
Can you have Medicare and Medicaid at the same time?
Yes. Some people receive benefits from both Medicare and Medicaid. These people are "dual eligible." They qualify for Medicare because of age (they're age 65 or older) or due to having a disability. They're also eligible for Medicaid because they meet the requirements to qualify for Medicaid in their state.
To see plans available in your area, please use the search box at the bottom of this page.
How do you qualify for both Medicare and Medicaid?
Medicare and Medicaid are two separate programs that have different eligibility requirements.
To qualify for Medicare, you need to be:
- At least 65 years old, or under 65 and qualify on the basis of disability or other special situations.
- A U.S. citizen or a legal resident who has lived in the U.S. for at least 5 years in a row.
To qualify for state Medicaid benefits, you need to be:
- Under age 65 and meet the requirements for low-income families, pregnant women and children, individuals receiving Supplemental Security Income (SSI), disability or other special situation.
- At least 65 years old and you also:
- Receive Extra Help or assistance from your state.
- Are blind or have a disability, but do not need long-term care.
How do Medicare and Medicaid work together?
Medicaid programs often cover benefits that aren't offered by Medicare. Examples could include dental, vision and hearing coverage, transportation assistance and long-term care. Paying for certain Medicare costs is another way Medicaid programs can help Medicare.
The overall goal is for both Medicaid and Medicare to work together more effectively to improve care and lower costs. It's the responsibility of the Medicare-Medicaid Coordination Office to make sure that people who are dually enrolled in both Medicare and Medicaid have full access to seamless, high quality health care. The Medicare-Medicaid Coordination Office was created within the Centers for Medicare & Medicaid Services (CMS) as part of the Affordable Care Act.
What are the advantages of a Dual Special Needs Plan (D-SNP)?
Dual health insurance plans offer benefits and services not typically available through Medicare or Medicaid. With a dual health plan, you'll keep your Medicaid benefits, and you'll get more benefits than Original Medicare with as low as a $0 plan premium. UnitedHealthcare dual health plans include a wide range of extra benefits and features.1
Our plans may cover:
- Routine dental care
- CA flexible monthly credit to spend on healthy food, over-the-counter products and pay utility bills
- Eye exams, plus credit for eyewear
- Hearing exams, plus credit for hearing devices
- And more
1Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply.
Some dual health plans also include care coordination. That's a big help — especially for people who have complex medical needs. It makes it easier to manage your doctors, specialists and care services.
Please note that the dual plans UnitedHealthcare offers, and the specific benefits they include, can change depending on where you live. For details about the dual plans available in your area, please use the search box at the bottom of this page.
D-SNP eligibility and enrollment
What are the eligibility requirements for Dual Special Needs plans (D-SNPs)?
1. Do you get state Medicaid benefits? (If so, you'll have a state Medicaid card.)
You are under age 65 and meet the requirements for low-income families, pregnant women and children, individuals receiving Supplemental Security Income (SSI), disability or other special situation.
- You are at least 65 years old and you also:
- Receive Extra Help or assistance from your state
- Are blind or have a disability, but do not need long-term care
2. Do you have Medicare Parts A and B?
- You're at least 65 years old, or you're under 65 and qualify on the basis of disability or other special situations
- You're a U.S. citizen or a legal resident who has lived in the U.S. for at least 5 years in a row
3. Do you live in an area where dual plans are available?
A UnitedHealthcare licensed sales agent can tell you if you live in our service area. Or, to see the plans available in your area, please use the search box at the bottom of this page.
When can you apply for a Dual Special Needs Plan (D-SNP)?
Dual Special Needs plans (D-SNPs) have an ongoing Special Enrollment Period (SEP), which runs for the first 9 months of the year. People who qualify can enroll or change plans once every 3 months. Enrollment changes will be effective the first day of the next month.
NOTE: It's important to remember that to stay eligible for a dual health plan, you must recertify for Medicaid every year. As long as you stay eligible, your dual health plan will renew automatically each year. Learn more about D-SNP enrollment.
How often can members in Dual Special Needs plans switch plans?
Members in Dual Special Needs plans (D-SNPs) can join, switch or drop their plan 1 time during each 3-month enrollment period. These periods are January to March; April to June; and July to September.
If you make a change, it will take effect on the first day of the next month. You can also make changes to your coverage during the Annual Enrollment Period from Oct. 15 to Dec. 7. If so, your changes will take effect on Jan. 1 of the next year. Learn more about dual health plan enrollment periods.
What happens when a D-SNP member loses Medicaid eligibility?
If you're enrolled in a UnitedHealthcare dual plan and you lose your Medicaid eligibility, we'll put you on hold for 6 months. During this time, you'll have to pay the Medicare cost-sharing portion such as copayments, coinsurance, deductibles and premiums. If you don't regain your Medicaid eligibility at the end of the 6 months, you’ll be unenrolled from our dual plan.
But remember, you can enroll in a dual plan at any time. If you get your Medicaid coverage back, just talk with a UnitedHealthcare licensed sales agent to re-enroll in a dual plan.
Is D-SNP enrollment by state?
Yes. Enrollment for Dual Special Needs plans (D-SNPs) is state-based. D-SNPs are offered in most states, but not all states. Also, the types of D-SNPs available (and the benefits each plan provides) can change depending on the county where you live. You can use the search box at the bottom of the page to see what plans are available in your area. If you're not sure, give us a call and talk with one of our licensed agents. They'll explain all the choices and help you find the right dual-eligible health plan for you.
When are the Medicare enrollment periods?
The Annual Enrollment Period or the Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage runs from Oct. 15 to Dec. 7 every year. Anyone who already has Medicare coverage of any kind can make changes to their coverage for the upcoming year. Medicare Advantage Open Enrollment Period runs from Jan. 1 to March 31 every year. Only people who already have a Medicare Advantage plan can change during this time.
What standard benefits are typically covered by UnitedHealthcare dual plans?
Our dual plans typically cover preventive care and routine services at no extra cost to you. We also offer help with coordinating Medicaid benefits. Other standard benefits that are usually covered by our dual plans include:
- Transportation assistance
- Nursing hotline
- And many other benefits and features1
1Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply. Learn more about D-SNP benefits.
Is dental coverage included with Dual Special Needs plans (D-SNPs)?
Yes. Dental coverage* is one of the many extra benefits you could get at no cost with a Dual Special Needs Plan (D-SNP) from UnitedHealthcare. Besides regular exams and cleanings, you may also get an allowance for dental services. This allowance could help pay for range a of dental care, such as fillings, root canals, implants and other dental services. Learn more about D-SNP dental coverage for those with Medicaid and Medicare.
*Benefits vary by plan and service area. Limitations and exclusions apply.
Is vision coverage included with Dual Special Needs plans (D-SNPs)?
Yes. Vision coverage* is one of the many extra benefits you could get at no cost with a Dual Special Needs Plan (D-SNP) from UnitedHealthcare. Besides routine eye exams, your vision coverage may also give you hundreds of dollars in credits to help pay for eyewear. That could go a long way toward helping pay for a new pair of glasses or contact lenses. Learn more about D-SNP vision coverage for those with Medicaid and Medicare.
*Benefits vary by plan and service area. Limitations and exclusions apply.
Do D-SNP members have subsidized premiums?
If you have a Dual Special Needs plan (D-SNP), it's likely that most of your costs will be covered for you. When Medicare members get medical care, Medicare doesn't cover the full amount of the services. The part or share that’s left over is the Medicare member's responsibility to pay. This may be known as a premium, copay, coinsurance or deductible. State Medicaid programs help pay these costs for low-income individuals. If you don't have Medicaid, your exact costs may depend on the plan you choose.
Does Medicare cover D-SNP members’ medical costs?
Yes. Since D-SNP is a Medicare Advantage plan, Medicare covers most of the costs when Medicare members get medical care. The part or share that’s left over is the member’s responsibility to pay. This may be known as a premium, copay, coinsurance or deductible. For people who are on a D-SNP plan, state Medicaid programs help pay these costs.
What is coordination of benefits?
Coordination of benefits (COB) applies to people who have coverage under more than one health plan. COB refers to which plan is the primary (first) payer and which plan is the secondary payer. The primary payer coordinates the delivery of all health plan benefits. The secondary payer covers what the primary payer doesn't cover on costs and benefits.
Dual Special Needs plans (D-SNPs) are a type of Medicare Advantage plan. As such, the D-SNP coordinates the delivery of both the Medicare and Medicaid benefits. In most cases, Medicaid covers benefits and costs the D-SNP doesn't cover. D-SNPs also coordinate care management, disease management and other clinical services.
Types of Medicare Special Needs plans
What is the difference between D-SNP and C-SNP?
D-SNP stands for Dual Special Needs plan. These plans are for low-income individuals who are dually eligible for both Medicaid and Medicare. C-SNP stands for Chronic Special Needs plan. These plans are for people who have a chronic health condition. Examples include chronic heart failure, cardiovascular disorders and diabetes.
What is the difference between D-SNP and Medicare-Medicaid plans (MMPs)?
Both Dual Special Needs plans (D-SNPs) and Medicare-Medicaid Plans (MMPs) are designed to make it easier for dual-eligible individuals to get care. These plans streamline access to care through Medicare and Medicaid. But there’s a key difference. With an MMP, all Medicare and Medicaid benefits are provided through 1 single health plan. With a D-SNP, members keep the same Medicaid plan and all the same Medicaid benefits as they get today. Plus, they have a separate Medicare Advantage plan that typically gives them more benefits and features than with Original Medicare. Another difference is that only people who are full dual eligible can enroll in an MMP, whereas it’s possible for both full and partial dual eligibles to get a D-SNP. Learn more about Medicaid benefits with D-SNPs.
Do all Special Needs Plans have Medicare Part D?
Medicare Part D is prescription drug coverage. It covers certain prescription drugs that aren't already covered by Medicare Parts A and B. Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage plan. Dual health plans include drug coverage. But if you take any prescription medicines, you'll want to make sure your drugs are covered by a dual health plan before you enroll. Learn more about dual health plan prescription drug coverage.
Are D-SNPs network-based?
Yes, Dual Special Needs plans (D-SNPs) are network-based. These plans require members to get care and services from doctors or hospitals in their Medicare SNP network. SNP networks vary in size and the populations they serve. Types of networks include:
- Networks covering a specified area. For example, one network may cover an entire state, while another network covers one county. Often, this means that an area might be served by more than one network.
- Networks dealing with a certain health issue, such as dementia. Providers who provide services to patients with the specified condition can join the network.
When you have a UnitedHealthcare dual plan, do you need to get a referral to see a specialist?
No. Referrals are not needed to get care from any in-network doctors, hospitals or clinics.
Where does UnitedHealthcare offer D-SNP health plans?
UnitedHealthcare Community Plan serves members who qualify for Medicaid or for both Medicaid and Medicare in 42 states and the District of Columbia.*
UnitedHealthcare offers Medicaid plans in these states:
Arizona, Colorado, Florida, Hawaii, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Missouri, Mississippi, North Carolina, Nebraska, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Virginia, Washington, Wisconsin
UnitedHealthcare offers Dual Special Needs plans (D-SNPs) in these states**:
Alabama, Arkansas, Arizona, California, Colorado, Connecticut, District of Columbia, Delaware, Florida, Georgia, Hawaii, Iowa, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maryland, Maine, Michigan, Minnesota, Missouri, Mississippi, Montana, North Carolina, Nebraska, New Jersey, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, West Virginia, Wyoming
*As of September 2023
**Not available in all counties
What type of plan am I eligible for?
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