The Medicare Agent's Guide to D-SNP Plans (Dual Eligible Special Needs)

Navigating the intricacies of Dual Eligible Special Needs Plans (D-SNPs) can be a game-changer for independent insurance agents seeking to capitalize on this rapidly expanding market. As D-SNPs gain traction this enrollment season, it’s critical to understand when clients can enroll and who qualifies.

In this blog, we'll explore D-SNPs in detail and give you the knowledge to help your beneficiaries get the most value from their coverage.

What Are Dual Special Needs Plans (D-SNPs) & Why Are They Gaining Popularity?

Dual Special Needs Plans (D-SNPs) are specialized Medicare Advantage plans designed for individuals who qualify for both Medicare and Medicaid. This group, often referred to as "dual-eligible," can benefit from these plans that integrate coverage from both programs to offer comprehensive care suited to their specific needs. One of the primary appeals of D-SNPs is their ability to streamline healthcare experiences. Participants often benefit from additional services beyond standard Medicare, including care coordination, gym memberships, and tailored prescription drug coverage, all at minimal out-of-pocket costs.

The rising popularity of D-SNP plans can be attributed to several factors. Primarily, as healthcare costs continue to climb, the cost-effectiveness and comprehensive nature of D-SNPs make them an attractive option for dual-eligible individuals. Because of this, carriers are expanding their D-SNP offerings as the market promises relatively high margins. 

KFF reported in 2011, only 12% of dual-eligible individuals were enrolled in an applicable D-SNP plan. However, by 2021, that number rose to nearly 30% — and the numbers continue to rise. This increase not only highlights demand but also signifies greater plan availability. In 2018, there were only 401 D-SNP plans available, but by 2024, that number had grown to 851.

Who Is Dual Eligible?

Generally speaking, anyone who qualifies for both Medicare and Medicaid is eligible for a D-SNP plan. According to the National Council on Aging, someone must:

• “Be a U.S. citizen or a lawful, permanent resident
• Qualify for original Medicare (Parts A & B)
• Meet the income and asset requirements for your state’s Medicaid program
• Live in a service area where D-SNPs are available”

Keep in mind that eligibility requirements may vary by plan provider, so be sure to check with them for rules regarding enrollment and other details you may need to know.

Who Benefits Most From D-SNPs?

Because those who qualify for these plans typically have more significant health needs, D-SNPs can be particularly beneficial for anyone who is dual-eligible. But these plans can be especially helpful for dual-eligible individuals with:

• Chronic health conditions requiring ongoing management and coordinated care
• Limited financial resources for those who need integrated Medicare and Medicaid benefits
• Complex healthcare needs spanning multiple services and providers
• Requirements for long-term care or community services not covered by traditional Medicare

The 3 Advantages of D-SNP Plans

1. Cost-Effective Coverage

A significant advantage of D-SNP plans is the financial relief they offer to dual-eligible individuals. With these plans, Medicare covers the initial portion of the expenses, while Medicaid covers the remaining costs. This effectively reduces out-of-pocket spending, which is a pressing concern for many beneficiaries. Moreover, D-SNPs often include zero-dollar cost-sharing arrangements, which further alleviate financial burdens on enrollees. Members who qualify for these plans generally do not incur a premium, making their coverage more affordable and accessible. 

2. Comprehensive Benefits

Beyond standard Medicare benefits, D-SNP plans often encompass additional advantages. These include prescription drug coverage under Medicare Part D and may potentially offer additional benefits, such as vision, dental, and hearing services, depending on the specific state Medicaid program. This expanded coverage is pivotal for individuals who may rely on these services more heavily due to age, income, or health concerns.

Some examples of these extra benefits can include:

• Dental
• Vision
• Hearing
• Nursing hotline
• Behavioral health
• Transportation assistance
• Monthly credits for food, OTC products, and more

3. Dedicated Care Coordinators

Notably, D-SNPs are also designed to deliver a higher level of care coordination, helping members navigate the complexities of Medicare and Medicaid, schedule appointments, and find appropriate services.

Care coordinators help D-SNP members navigate their healthcare needs by:

• Reducing paperwork burdens
• Ensuring timely, appropriate care
• Eliminating duplicate services
• Providing better health outcomes

By understanding these advantages, independent agents can better position D-SNP plans as a cost-effective, comprehensive solution for clients who require both Medicare and Medicaid services.

When Can You Enroll in a D-SNP?

Enrollment in D-SNPs can occur during various periods, including the Initial, General, and Open Enrollment Periods, or through a Special Enrollment Period triggered by qualifying life events.

Special Enrollment Period (SEP)

For those with both Medicare and Medicaid, you have the advantage of using a Special Enrollment Period (SEP) that allows you to enroll in an integrated D-SNP at almost any time. This is particularly beneficial if you’ve recently gained Medicaid eligibility or experienced certain qualifying life events, such as relocating out of your current plan’s service area, as detailed by the Centers for Medicare & Medicaid Services.

General Enrollment Periods

Apart from the SEP, enrollment in D-SNPs can also occur during other designated periods. The Initial Enrollment Period, which starts three months before an individual turns 65 and continues for seven months, is crucial. Meanwhile, the General Enrollment Period from January 1st to March 31st each year offers another opportunity. Following this period, new enrollees may choose Medicare Advantage between April and June.

Set Your Clients up for Success

For independent agents, leveraging technology like AgencyBloc’s AMS+ solution is essential. AMS+ allows agents to easily organize and manage D-SNP plans, ensuring they can quickly determine which clients may benefit the most from these offerings, especially given potential shifts in carrier offerings this year. By utilizing AMS+, agents can effectively manage client information and navigate the changes in plan provisions, ensuring that their clients' coverage needs are consistently met as the market landscape evolves.

This year, many carriers are anticipated to adjust their offerings, making it crucial for agents like you to stay adaptive. With AMS+, you have a powerful ally to track these changes and strengthen client relationships.

Posted by Sarah Rosonke on Tuesday, July 1, 2025 in Senior Market Insurance

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