How Do Medicare Advantage DSNP Plans Work?

Many people don’t realize there are several different kinds of Medicare Advantage plans. Coverage and benefits vary greatly between the types of plans, so it’s important to know what kind you’re enrolling in.

One type of Medicare Advantage plan is called a Special Needs Plan, which is reserved for people who meet certain requirements. Within this subset of plans, there are three different kinds: ISNPs, CSNPs, and DSNPs. Today, we’re going to learn more about the DSNP option.

What Is a Medicare Advantage DSNP?

DSNP (also known as DE-SNP or D-SNP) stands for Dual-Eligible Special Needs Plan. DSNPs are reserved for Medicare beneficiaries who are also eligible for Medicaid.

Medicaid is a national program dedicated to offering financial assistance to certain groups of people. When it comes to DSNPs, it is specifically for individuals with limited incomes. Each state administers its own Medicaid program, so requirements and benefits may vary.

Private insurance companies can choose to offer Medicare Advantage plans as long as they’ve been approved by the Medicare program and the Centers for Medicare and Medicaid Services (CMS). However, not all carriers offer DSNP options, and plan availability depends on your zip code.

In addition, benefits included in a DSNP plan may vary between carriers and between service areas. The same is true of other kinds of Medicare Advantage plans. Generally speaking, DSNPs have $0 premiums and no cost-sharing for approved services. 

On top of their medical benefits, DSNPs include many extra benefits you won’t find in Original Medicare or Medicaid. Benefits could include dental, vision, and hearing coverage, transportation, over-the-counter stipends, gym memberships, meal delivery, utility payments, and more. Some plans include more than $10,000 worth of extra benefits.

How Do I Choose a DSNP?

The first step in choosing a Medicare Advantage DSNP is determining if you’re eligible. As we mentioned, every insurance company is different. Some only accept one level of Medicaid, while others open their enrollment up to individuals enrolled in any form of Medicaid assistance. The easiest way to determine which plans you’re eligible for is to speak with an independent insurance agent, like the ones at Local Medicare Specialists!

If you are eligible for a DSNP and have more than one option in your zip code, you’ll need to compare both plans. Here are three key things to look for.

Provider Network

Most DSNPs operate under a Health Maintenance Program (HMO). That means that there is only coverage within the HMO network. Therefore, it is vitally important that you receive care from a provider who is contracted with your plan. Be sure to know which providers accept your plan and only see providers who are contracted with it.

Prescription Drug Formulary

DSNPs include prescription drug coverage, typically with no copays. However, a medication must be included in the plan’s drug formulary in order for it to be covered. If you are taking a medication that is not in the plan’s formulary, ask your doctor about switching to a covered medication, or be prepared to pay out-of-pocket for your refills.

Extra Benefits

After looking at the provider network and drug formulary, you may have already narrowed your selection down to one plan. However, if there are still several plans to choose from, consider the extra benefits. How does the dental coverage compare from one plan to the next? Does one plan offer more over-the-counter benefits? Decide which extra benefits are most important to you.

How to Enroll in a Medicare Advantage Plan

If you are eligible for a DSNP plan, you can enroll at any time. Gaining or losing Medicaid eligibility offers you a Special Enrollment Period, which allows you to enroll in a DSNP outside of the Annual Election Period.

Once enrolled, you can change your DSNP plan once per quarter for the first three quarters of the year. It is not recommended that you frequently change your plan, but if your provider goes out-of-network or your current plan is not offering coverage for a new prescription, it may be worth looking at other DSNPs in your area.

Lastly, you should always have your plan reviewed during the Annual Election Period (AEP), which occurs annually from October 15 through December 7. During this time, you can learn about how your current plan might be changing in the following year. If you make a change during this time, the new plan will begin on January 1.

To look at DSNPs in your zip code, call the Local Medicare Specialists today!