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Dual Eligible Special Needs Plan (D-SNP)

A Dual Eligible Special Needs Plan (D-SNP) is a type of health plansA group of doctors, specialists, clinics, pharmacies, hospitals, and long-term services and supports providers that work together to meet your needs (also called a managed care plan).
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that manages all your MedicareThe federal program that provides health care benefits for people age 65 years and older as well as people of any age with certain disabilities or diseases.
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and some Medi-CalA government program that offers health care coverage for low-income Californians. (Medi-Cal is the federal-state Medicaid program in California.)
benefits, and includes some extra benefitsPayment of health care services and products. Medicare benefits pay for doctor visits, hospital care, prescription drugs, and some behavioral health services.
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.

  • To qualify for a D-SNP health plan, you must have Medicare and Medi-Cal and live in a ZIP code where a D-SNP is available.
  • You will continue to get benefits from Medi-Cal like you do today, such as long-term services and supportsA variety of services aimed at helping people with daily living activities.
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     (like In-Home Supportive Services (IHSS)The IHSS program provides in-home care for people who cannot safely remain in their own homes without assistance.
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     or adult day centersFacilities that provide social activities and meals and sometimes nursing and therapies during the day.
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    ).
  • You might get a helper (like a nurse or care manager) to be your main point of contact and make sure you get all the care you want and need.
  • You will have to use providersA person or organization that provides health care-related services, like a doctor, hospital, or clinic.
    >
     in your health plan’s network. (If your providers are not in the network, you can get help finding providers that are.)

Ready to Enroll >

My Choices 
Benefits 

Benefits

  • The D-SNP health plan manages most of your Medicare benefits (including doctors, hospitals, prescription drugs, lab tests, x-rays, and some medical equipmentThis is equipment ordered or prescribed by your doctor to use at home.
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    .
  • The D-SNP health plan provides SOME of your Medi-Cal benefits (including medical suppliesMedically related supplies often ordered or prescribed by a doctor. They are typically disposable and used once. They include diabetic test strips, oxygen, and incontinence supplies.
    and transportationPayment of medically necessary transportation. This can include ambulance, wheelchair van, taxi, ride-share service, or public transportation.
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    .
  • Other Medi-Cal benefits will still come from Medi-Cal, not the D-SNP health plan. These include long-term services and supports (like IHSS, adult day centers, and nursing home care). You keep these services and providers the way they are now.
    • But the D-SNP plan can help make sure you get all the Medi-Cal benefits you need, including long-term services and supports.
  • As with other options, you keep all of your Medicare and Medi-Cal benefits. You don’t lose any of your Medi-Cal benefits.
  • You might also get extra benefits like:
    • Extra dental, hearing, and vision coverage
    • Extra help so you can live in your home safely (like shower grab bars and ramps)
    • Gym membership
  • You may get a care coordinator—a nurse or other helper whose job is to be your main point of contact and help you get all the health care services you need.

Considerations

  • D-SNP health plans have networks of providers (like doctors, hospitals, clinics, labs, and equipment suppliers). The health plan will ask you to use the providers in their networkA group of doctors, hospitals, pharmacies, and other health care providers that work with your health plan to provide your health care services.
    .
    • If your doctor or hospital is not already in the health plan’s network, they might have to join the network, or you may have to switch. You may also have to switch where you get your medical supplies and equipment.
    • Your D-SNP health plan can help you find new doctors and service providers that meet all your needs.
Success Stories 
Next Steps 

How to Enroll

You can enroll by:

  • Calling your D-DNP health plan.
    • Find your local health plans under the “My Choices” tab on this page.
  • Calling 1-800-MEDICARE (TTY: 1-877-486-2048).

You cannot enroll in a D-SNP online. You must call the plan to enroll and/or to get more information about their specific benefits.

Download Helpful Tools

Use these tools to understand your next steps and organize your health information:

Contact Help Services

Visit our Get Help page for links and phone numbers to people who can help you understand your Medicare and Medi-Cal benefits and assist you in choosing a coverage option.

Explore More About D-SNP

Medicare.gov

CMS Dual Eligible Special Needs Plans

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