If you have both Medicare and Medicaid, you have probably heard the letters DSNP and wondered what they mean for you. So what is a DSNP? A DSNP, short for Dual Special Needs Plan, is a kind of Medicare Advantage plan built for people who qualify for both Medicare and Medicaid at the same time. It brings the two programs together into one plan, it’s almost always $0 a month, and it usually adds benefits that plain Medicare doesn’t include.
People who have both programs are called dual eligible, and DSNPs exist just for them. In this guide we’ll walk through what a dual special needs plan is, who qualifies, what it covers, and how to find out if one is offered where you live. It’s all in plain language, and a licensed agent is a phone call away if you want help.
What is a DSNP, in plain words
A DSNP is a Dual Special Needs Plan. It’s one of several types of Medicare Advantage plan, which is the private plan option inside Medicare. What makes a DSNP special is that it’s designed only for people who have both Medicare and Medicaid, and it’s set up to make those two programs work together instead of leaving you to juggle them on your own.
Think of it this way. Medicare is your main health coverage once you turn 65, or earlier if you qualified through a disability. Medicaid is the program that helps people with a limited income pay for care. When you have both, a dual special needs plan wraps them into a single plan with one card, one set of benefits, and help coordinating your care.
DSNPs have been part of Medicare since 2006, and in 2018 they were made a permanent part of the program. That matters, because it means a dual plan isn’t a limited time offer or a gimmick. It’s a lasting option that millions of people already use.
Who qualifies for a dual special needs plan
To join a DSNP, you generally need three things to be true. First, you have Medicare, usually both Part A and Part B. Second, you also qualify for Medicaid, or you have a low enough income that your state helps with your costs. Third, a dual plan is offered in the county where you live, since these plans are approved area by area.
Here’s something a lot of people miss. Many who qualify for Medicaid help don’t realize it, especially those living on a fixed income. If you’re not sure whether you have Medicaid or would qualify for it, that’s worth checking, because it can be the key that unlocks a dual plan. You can read more in our guide on how to tell if you are dual eligible, or call and let a licensed agent check for you.
It also helps to understand how the two programs differ, since a DSNP sits right where they overlap. Our plain English look at Medicare versus Medicaid breaks that down.
What benefits does a DSNP include
This is the part most people care about, and for good reason. Beyond your regular Medicare coverage, a dual special needs plan often adds extras that plain Medicare leaves out. Exactly what you get depends on the plan and your county, and the extras apply to members who are eligible, but here’s what many DSNPs offer.
Usually a $0 monthly premium
Most dual plans cost $0 a month, and your Medicaid often helps cover other costs like copays. That’s a big relief for anyone on a tight budget. What you pay in the end depends on the plan you pick and your own situation.
A grocery and over the counter card
Many DSNPs load a set amount onto a card each month that you can use for groceries and over the counter items such as vitamins, pain relievers, and first aid supplies. The amount is set by the plan, it’s up to a limit, and it’s only for members who qualify. It’s a plan benefit, not free government money, but for a lot of people it makes a real difference at the register.
Dental, vision, and hearing
Original Medicare usually doesn’t cover routine dental work, eyeglasses, or hearing aids. Many dual plans do. That can mean cleanings and dental care, an eye exam and glasses, and help with hearing aids, all through your one plan.
Rides to your appointments
Getting to the doctor is hard for some people, so many DSNPs include transportation to and from medical visits and the pharmacy. If a ride has ever been the reason you skipped an appointment, this benefit alone can be worth a lot.
Prescription drug coverage
Dual plans build in Medicare Part D prescription drug coverage, so your medications are part of the same plan. Because many dual members also get Extra Help and Medicaid support, prescriptions often cost very little.
Care coordination
Because a DSNP combines Medicare and Medicaid, it can help the two programs talk to each other. Some plans give you a care coordinator who helps you find providers, understand your benefits, and keep your care on track.
Do you keep your Medicaid and your doctor
Yes, you keep your Medicaid. A dual special needs plan is built to work together with your Medicaid, not to replace it. You keep your Medicaid benefits, and the DSNP coordinates your Medicare coverage right alongside them.
As for your doctor, dual plans use networks, much like other Medicare Advantage plans. That means it’s smart to check whether your doctors and your pharmacy work with a plan before you switch. A licensed agent can look that up for you in a few minutes, so there are no surprises.
How much does a DSNP cost
For most people, a dual plan is $0 a month. On top of that, your Medicaid often picks up costs that other people on Medicare would pay themselves, like certain copays and deductibles. Your actual out of pocket costs depend on your plan, your level of Medicaid, and where you live, so treat any number you see as a sample rather than a promise. The clearest way to know your real numbers is a quick, free call.
How to find out if a dual plan is right for you
If you have both Medicare and Medicaid, or you think you might qualify for Medicaid, a dual special needs plan is worth a look. Dual plans are sold county by county, so the ones near you may differ from the ones a friend has in another state. A licensed agent can confirm you qualify, look up the DSNPs offered where you live, compare what each one includes, and help you enroll over the phone if you decide to move forward.
There’s no cost and no obligation to ask. You can learn more about how these plans work in our overview of what a dual plan is, and when you’re ready, a real person is here to help.
Key takeaways
- A DSNP is a Dual Special Needs Plan, a Medicare Advantage plan for people who have both Medicare and Medicaid.
- It’s usually $0 a month and often adds a grocery and over the counter card, dental, vision, hearing, transportation, and prescription coverage, if you are eligible.
- You keep your Medicaid, and your Medicare works alongside it in one plan.
- Benefits vary by plan and county, so check what is offered where you live.
- A licensed agent can confirm you qualify and find your local plans for free.
Frequently asked questions
What does DSNP stand for?
DSNP stands for Dual Special Needs Plan. The word dual means you have both Medicare and Medicaid, and the plan is built for that situation.
Is a DSNP the same as Medicare Advantage?
A DSNP is a type of Medicare Advantage plan. The difference is that it’s made only for people who have both Medicare and Medicaid, and it adds benefits and care coordination for them.
Will a dual plan take away my Medicaid?
No. You keep your Medicaid. A dual plan works together with it and coordinates your Medicare benefits at the same time.
How do I know if I qualify?
If you have Medicare and either have Medicaid or a limited income, you may qualify. The fastest way to be sure is to call and let a licensed agent check for you.
Talk to a licensed agent
If you have both Medicare and Medicaid, you may be leaving real benefits on the table. Call to see if you qualify for a $0 dual plan where you live. It’s free, there’s no obligation, and it only takes a few minutes.
Call (800) 000-0000My Dual Plan is a private information and referral service. We are not an insurance company, agency, or licensed producer, and we do not sell insurance. When you call, you are connected with a licensed insurance agent who can discuss the dual special needs plans they offer in your area. We are not affiliated with, endorsed by, or connected to Medicare, Medicaid, the Centers for Medicare and Medicaid Services, or any government agency. We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer in your area. Please contact Medicare.gov or 1 800 MEDICARE to get information on all of your options. Benefits, the grocery and over the counter allowance, and other extras vary by plan, county, and carrier, are provided up to a set limit if you are eligible, and are not guaranteed.