Dual Eligible Special Needs Plans help coordinate Medicare and Medicaid benefits

A Dual Eligible Special Needs Plan (D-SNP) is a type of Medicare Advantage plan designed for people who are eligible for both Medicare and Medicaid. Currently, nearly 3.8 million individuals are enrolled in a D-SNP across the 45 states offering them. While 12 million individuals across the U.S. qualify for enrollment in a D-SNP, many are not enrolled.

Individuals who are dually eligible for Medicare and Medicaid are more likely to experience challenges in accessing health care services, lower quality of care, and below-average health outcomes when compared with the general population. Sixty-two percent of individuals who are eligible for a D-SNP manage chronic conditions and 64% have a mental health diagnosis. Centralizing care from Medicare and Medicaid through a D-SNP makes health care easier to navigate.

Integrated care coordination supports complex medical and social needs

D-SNPs have extensive care coordination requirements that enable more integrated, effective care and continuity for this diverse, high-needs population. This allows the managed care organization to assess comprehensive needs, identify health issues before they worsen, and implement a person-centered care plan that offers timely, coordinated services and improved health outcomes.

The care manager is able to specifically tailor the care plan to meet the individual’s needs while accessing both Medicare and Medicaid benefits. This improves both the care experience and health outcomes for members.

This coordination lowers costs by removing duplicative and unnecessary services and ensuring that members receive the care they need when they need it.

2023 changes enhance opportunities for holistic care planning

Starting in 2023, the Centers for Medicare & Medicaid Services (CMS) will require plans to add new questions related to housing stability, food security, and transportation access for members’ Health Risk Assessments. These social determinants of health must be addressed in the individual’s plan of care.

The new rules create opportunities for states to monitor quality ratings more completely and to align D-SNPs more closely with their Medicaid programs.

Learn more about D-SNPs

This blog has only scratched the surface of all there is to know about D-SNPs. Learn more about how D-SNPs help members understand the benefits of both Medicaid and Medicare and how coordinating those benefits helps ensure that the most appropriate care is provided for members’ needs. For more in-depth information about these plans, we’ve created a new series of fact sheets that are linked below.

DSNP 101: About Dual Eligible Special Needs Plans (D-SNPs)
DSNP 201: Value of Dual Eligible Special Needs Plans (D-SNPs)
DSNP 301: Coordination and Integration

Get updates on Medicaid topics you care about

Be the first to know about relevant news & insights by subscribing to our newsletter.