Dual Eligibles
Persons eligible for both Medicare and Medicaid, with Medicare paying first and Medicaid covering premiums, cost-sharing, and services Medicare omits.
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Practice This Concept
A Dual Eligible Special Needs Plan (D-SNP) under Medicare Advantage is designed for individuals who:
Are eligible for both Medicare and Medicaid and need coordinated benefits, including coverage of Medicare cost-sharing — A D-SNP is a special needs plan for people eligible for both Medicare and Medicaid, known as dual eligibles. It coordinates Medicare and Medicaid benefits so that Medicare cost-sharing not paid by Medicare can be covered through Medicaid, including any applicable share of cost. D-SNPs combine the protections of both programs for a particularly vulnerable population.
National insurance concept
A Medicare Advantage Special Needs Plan for dual-eligible beneficiaries (D-SNP) is designed for individuals who:
Qualify for both Medicare and Medi-Cal, coordinating benefits including any Medi-Cal share of cost — A D-SNP is a Medicare Advantage Special Needs Plan serving dual-eligible beneficiaries, people enrolled in both Medicare and Medicaid (Medi-Cal in California). The SNP coordinates the two programs and may address the beneficiary's Medi-Cal share of cost. SNPs target defined populations: dual-eligibles (D-SNP), institutionalized persons (I-SNP), and those with chronic conditions (C-SNP). The dual-eligible/share-of-cost point is in the Part C objectives.
CA-specific example
- Medical ExpenseA Dual Eligible Special Needs Plan (D-SNP) under Medicare Advantage is designed for ind…
- State RegulationsA Medicare Advantage Special Needs Plan for dual-eligible beneficiaries (D-SNP) is desi…
- Medical ExpenseA D-SNP, or dual-eligible Special Needs Plan, is a Medicare Advantage plan designed for…
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