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What is a Dual Special Needs Plan?

Dual Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare and medical assistance from a state plan under Medicaid.  States cover some Medicare costs, depending on the state and the individual’s eligibility.

Medicaid Eligibility Categories

D-SNPs With or Without Medicare Zero-Dollar Cost Sharing

D-SNPs With or Without Medicare Zero-Dollar Cost Sharing

The Medicaid eligibility categories encompass all categories of Medicaid eligibility including:

  • Full Medicaid (only);
  • Qualified Medicare Beneficiary without other Medicaid (QMB Only);
  • QMB Plus;
  • Specified Low-Income Medicare Beneficiary without other Medicaid (SLMB Only);
  • SLMB Plus;
  • Qualifying Individual (QI); and
  • Qualified Disabled and Working Individual (QDWI).

D-SNPs With or Without Medicare Zero-Dollar Cost Sharing

D-SNPs With or Without Medicare Zero-Dollar Cost Sharing

D-SNPs With or Without Medicare Zero-Dollar Cost Sharing

At the time of plan creation, each D-SNP must identify whether or not if offers Medicare zero-dollar cost sharing.  In HPMS, D-SNPs will have the option of one of the following two indicators:

  1. Medicare Zero-Dollar Cost Sharing Plan, or
  2. Medicare Non-Zero Dollar Cost Sharing Plan.  

These two indicators will be used in multiple areas within HPMS and are essential to the proper display of benefits in Medicare Plan Finder.

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