Medicare Advantage Plans vs. D-SNP: What’s the Difference?
Foreword from Denise Austin
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Creator of Fit Over 50 Magazine
Hi everyone! Most people don’t realize how important their insurance plan is beyond how much you pay for when going to the doctor. Having the wrong plan can cause people to miss out on benefits and take a bigger bite out of their wallets – especially for people who qualify for Medicaid. My friends at Ensurem have written the easy-to-understand breakdown of the differences!
Do you have Medicaid and Medicare? If so, you likely qualify for a tailored health insurance plan called Dual-Eligible Special Needs Plan, or D-SNP.
D-SNPs are Medicare Advantage Plans that combine your Medicare, Medicaid and extra health benefits – all in one easy plan that’s just right for you.
While they’re similar to standard Medicare Advantage Plans in many ways, there are a few key differences – especially as a Medicaid enrollee on a fixed income. With that in mind, let’s discuss the difference between a standard Medicare Advantage Plan and a D-SNP.
What is a Medicare Advantage Plan?
A Medicare Advantage Plan is an alternative to Original Medicare Part A and Part B.
Also called Medicare Part C, Medicare Advantages Plans combine your Part A (hospital insurance) and Part B (Medicare insurance) into one plan. It’s also common for Medicare Advantage Plans to include additional benefits and coverage not offered by Original Medicare, like:
- $0 monthly premiums
- Prescription drug coverage
- Vision, dental and/or hearing insurance
- Medical appointment transportation
- Post-hospitalization meal delivery
- Fitness programs
Medicare Advantage Plans come in many forms. Each varies in cost, flexibility and eligibility requirements. The types of Medicare Advantage Plans include:
- Health Maintenance Organization (HMO)
- HMO Point-of-Service (HMO-POS)
- Medical Savings Account (MSA)
- Private Fee-for-Service (PFFS)
- Special Needs Plan (SNP)
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What is a D-SNP?
Before we break down what a D-SNP is, we need to discuss its parent category – the SNP.
Special Needs Plans are a form of Medicare Advantage Plan specifically designed to provide targeted care and limit enrollment to individuals that meet specific needs.i There are three types of SNPs, includingii:
Chronic Condition SNP (C-SNP): For those with a severe or disabling chronic condition, such as End-Stage Renal Disease (ESRD), dementia, HIV/AIDS, chronic heart failure, etc.
Institutional SNP (I-SNP): For those who live in an institution such as a nursing home or require nursing care at home.
Dual-Eligible SNP (D-SNP): For those with both Medicare and Medicaid.
D-SNPs are designed to work together with your Medicaid plan and often come with additional benefits and resources not typically offered by Original Medicare or Medicare Advantage Plans alone.
What’s the Difference Between a D-SNP and other Medicare Advantage Plans?
If you qualify for both Medicare and Medicaid, and you’re comparing Medicare Advantage Plans, you’ll quickly find out that the choice is easy – go with a D-SNP if it’s available.
D-SNPs come with some notable features which make them the obvious option. Here are three of the most significant positives in choosing a D-SNP over any other Medicare Advantage Plan if you have both Medicaid and Medicare.
One of the most significant differences between a D-SNP and Medicare Advantage Plans is that D-SNPs come with a dual-plan care coordinator. These coordinators are employed by your insurance provider and help you navigate the challenges of finding doctors and specialists that accept both Medicare and Medicaid and are within your network of care.
Medicare Advantage SNPs cover the same Medicare services that all Medicare Advantage plans must cover; however, you’ll notice that D-SNPs often come with additional benefits not usually offered in a Medicare Advantage Plan or have benefits with greater allowances toward specific services.
For example, like all SNPs, D-SNPs must cover prescription drugs while not all Medicare Advantage Plans cover prescription drugs.
Other benefits you may find with a D-SNP not associated with other Medicare Advantage Plans include:
- Coverage of acupuncture visits
- Podiatry services such as routine clipping of toenails
- Complimentary personal emergency response systems
- Monthly healthy food allowances
- Personal home care such as meal prep and house cleaning
- Funds for over-the-counter products such as toothpaste or supplements
If you have both Medicare and Medicaid, most of the costs of joining a Medicare D-SNP will be covered. Medicaid typically pays the Medicare Part B monthly premium when you qualify for dual eligibility. If you have any other Medicare Advantage Plan, you may be required to pay your Medicare Part B monthly premium and your MA Plan premium if it’s not an MA plan offering $0/month. In 2022, the Part B premium is $170.10 per month.iii
Interested in Enrolling in a D-SNP?
If you’re interested in joining a D-SNP, it’s important to note that SNPs have multiple special enrollment periods throughout the year. These enrollment periods allow people who have Medicaid, Medicare Part A and Part B, and live in a plan’s service area to enroll, disenroll or switch plans once a quarter for the first three quarters of the year. The year’s final quarter is the Medicare Annual Enrollment Period which is open to all Medicare enrollees to change their plan.
If you wish to learn more about the D-SNPs available in your area, Ensurem is here to help. Our licensed insurance agents can help you compare plans and determine which plan gives you the most benefits to fit your needs.
Call the number above to speak with a licensed insurance agent. If you’re not interested in speaking to an agent, Emma is here to help. Emma is your virtual Medicare assistant1 and will help you determine which plan is best for you 100% online from the comfort of home. Learn if you’re eligible for a D-SNP plan and discover which plans are available in your area.
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Education is crucial in finding the right Medicare solution for you. With so many Medicare resources out there, it can be difficult finding a source you can trust. That’s why Ensurem has a Compliance Program dedicated to ensuring our Medicare content meets Centers for Medicare & Medicaid Services (CMS) regulations. So, you can rest assured you’re getting the information you need to make the right coverage decisions.
1Emma is a virtual assistant and is not a live person. To speak with a live, licensed agent call the phone number on your screen. Ensurem, LLC., is a licensed and certified representative of Medicare Advantage HMO, PPO and PPFS organizations and stand-alone prescription drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal. Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call the Plan’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. These plans have eligibility requirements, exclusions and limitations. For costs and complete details (including outlines of coverage), call a licensed insurance agent at the toll-free number shown.
i “Special Needs Plans,” Dec. 1, 2021, U.S. Centers for Medicare & Medicaid Services, https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans
ii “How Medicare Special Needs Plans (SNPs) Work,” Medicare.gov, https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/how-medicare-special-needs-plans-snps-work
iii “2022 Medicare Parts A & B Premiums and Deductibles/2022 Medicare Part D Income-Related Monthly Adjustment Amounts,” Nov. 12, 2021, Centers for Medicare & Medicaid Services, https://www.cms.gov/newsroom/fact-sheets/2022-medicare-parts-b-premiums-and-deductibles2022-medicare-part-d-income-related-monthly-adjustment
Denise Austin, 65, Ensurem Ambassador
Best-Selling Author, Creator of Fit Over 50 Magazine
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