What is a D-SNP (dual eligible special needs plan)?
A Medicare Advantage plan built for people who have both Medicare and Medicaid. Common in Hidalgo County and often missed.
- A D-SNP is a Medicare Advantage plan for people who have both Medicare and Medicaid.
- There are two levels, full and partial, and you do not need full Medicaid to join every D-SNP.
- Getting screened costs you nothing, so ask before you decide you do not qualify.
A D-SNP is a Dual Eligible Special Needs Plan. It is a Medicare Advantage plan built for people who have both Medicare and Medicaid. Medicaid is the state program that helps pay health costs for people with low income.
Dual eligible means you have both. A lot of people in this county do.
Who qualifies
You have to be signed up for Medicare. You also have to qualify for Medicaid, or for a Medicare Savings Program in Texas. A Medicare Savings Program is a state program that pays part of your Medicare costs.
There is more than one level, and you do not need full Medicaid to get into every D-SNP.
- Full dual eligible. You have Medicare and full Texas Medicaid.
- Partial dual eligible. You qualify for a Medicare Savings Program, which goes by initials like QMB, SLMB or QI. It helps with your Medicare costs, but it does not give you full Medicaid benefits.
Many people who could get a Medicare Savings Program never apply. They assume the income limit is lower than it really is. See how the two programs work in Texas.
Why these plans are different
A D-SNP puts both programs under one roof. You do not have to work out which one pays for what.
- What you pay is usually very little or nothing, because Medicaid picks up what Medicare does not.
- Benefits are built around the long term health problems that are common in this group.
- Care coordination is usually part of the plan. That means someone at the plan helps you line up your care.
- Extra benefits tend to be bigger. They often include rides to appointments and an allowance for over the counter items at the drug store.
- Drug coverage is built in. If you are dual eligible you also get Extra Help, a program that lowers what you pay for your drugs.
The enrollment advantage
Most people can only change plans in the fall. Dual eligibles get more room than that.
When your eligibility changes, you generally get a special enrollment period. That is a window to join or switch outside the usual fall dates. You also get extra chances to switch during the year.
The exact rules depend on your level. Ask, rather than assume you have to wait until October.
Why this matters in Hidalgo County
Hidalgo County has a high share of people on Medicare Advantage. It also has a large dual eligible population. So D-SNPs are widely offered here, and plans compete hard for that business.
It also means many people pay Medicare costs they do not have to pay. Nobody ever checked whether they qualified for Medicaid or a savings program.
If your income is limited, get screened before you decide you do not qualify. A Medicare Savings Program can pay your Part B premium for you. Part B is the part of Medicare that covers doctor visits, and the premium is the monthly bill for it. You would see that as a bigger Social Security deposit each month, and it can open the door to a D-SNP.
How to find out where you stand
- Apply for Medicaid and Medicare Savings Programs through Texas Health and Human Services at yourtexasbenefits.com. That is a different agency from Social Security.
- If you are approved at any level, ask what enrollment window that opens for you.
- Compare the D-SNPs open to you the same way you would any Advantage plan. Look at the network, the doctors and hospitals under contract with the plan.
- Look at the formulary too, which is the list of drugs the plan pays for.
- Check that your own doctors are in the network before you sign up.
The screening costs you nothing and takes one short talk. If you are not sure where you stand, that is the moment to ask. Call our McAllen office at (956) 687 3334, or use the ZIP code form on this page.
Common follow-up questions
Do I need full Medicaid to join a D-SNP?
Not always. Some D-SNPs take partial dual eligibles, people who qualify for a Medicare Savings Program but not for full Medicaid. It depends on the plan.
What happens if I lose Medicaid eligibility?
There is usually a grace period first. After that you would move to another plan. Losing eligibility opens a special enrollment window, so you get a chance to pick.
Are D-SNPs only for people with disabilities?
No. The D stands for dual, meaning you have both Medicare and Medicaid. Other Special Needs Plans exist for long term health problems and for people in a nursing home, and those are different.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. There is no obligation to talk it through.
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Gerino Alejos
Licensed insurance agent · License 3128710 · NPN 18243381
Owner of McAllen Insurance Group, an independent agency on North 10th Street in McAllen. Works with clients across Hidalgo, Cameron and Starr counties on Medicare, Marketplace health, life and auto coverage. Se habla español.