What is the difference between dual eligible and DSNP?
Asked by: Dr. Mertie Stehr | Last update: October 16, 2025Score: 4.5/5 (7 votes)
What is the difference between dual and DSNP?
Dual Special Needs Plans are for people who have both Medicare and Medicaid (called "dual eligible"). A Dual Special Needs Plan (D-SNP) is a unique Medicare Advantage plan that combines your Medicare Part A and Part B benefits, and your Medicare Part D prescription drug coverage.
What does a dual eligible patient mean?
Dually Eligible Individuals – Categories. Revised 09/06/2024. People who are entitled to both Medicare and Medicaid, also known as dually eligible individuals, fall into several eligibility groups. These individuals may either be enrolled first in Medicare and then qualify for Medicaid or vice versa.
Who is eligible for DSNP?
Dual Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual's eligibility.
What is the difference between QMB and QMB+?
Medicaid, also known as Medical Assistance or QMB Plus, provides benefits for services not normally covered by Medicare. QMB, which is partial Medicaid, helps pay for services only if they are covered by Medicare.
What Are Dual Special Needs Plans (D-SNP)?
Is QMB dual eligible?
Dual Eligible QMBs
Qualify for full MC, Medicare Part A, and have income at or below the QMB income limit, including: Some ABD-MN individuals. SSI/SSP recipients with or without “free” Part A.
What is dual eligible for Medi Medi?
Some people qualify for both Medicare and Medi-Cal and are “dual eligible” or Medi Medi beneficiaries. When an individual has both Medicare Parts A and B, Medicare is the primary insurance and pays for most medical care.
What does DSNP mean in Medicare?
Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage (MA) plans that provide specialized care and wrap-around services for dual eligible beneficiaries (eligible for both Medicare and Medicaid).
How to become dual eligible for Medicare and Medicaid?
To be dual eligible, persons must also be enrolled in either full coverage Medicaid or one of Medicaid's Medicare Savings Programs (MSPs). Full coverage Medicaid covers physician visits, hospital services (in-patient and out-patient), laboratory services, and x-rays.
What are the three types of special needs plans?
- Chronic Condition SNP (C-SNP)
- Dual Eligible SNP (D-SNP)
- Institutional SNP (I-SNP)
What are the four levels of Medicaid?
Broadly, there are four major eligibility groups covered by most states: Children, Adults with Disabilities, Aged Adults, and Nondisabled Adults.
What are the enrollment periods for DSNP?
Dual Special Needs plans (D-SNPs) have an ongoing Special Enrollment Period (SEP), which runs for the first 9 months of the year. People who qualify can enroll or change plans once every 3 months. Enrollment changes will be effective the first day of the next month.
Can you have two primary care doctors with Medicare?
If you have Original Medicare, you can have two PCPs if you feel it's necessary (e.g., you live in multiple states, or your work requires frequent/extended travel). Medicare doesn't limit the number of PCPs you can have. However, you can't consult them on the same calendar day.
What best describes a DSNP?
D-SNPs are Medicare Advantage (MA) plans that provide specialized care to beneficiaries dually eligible for Medicare and Medi-Cal and offer care coordination and wrap-around services. All D-SNPs in California must have executed contracts with the Department of Health Care Services (DHCS), the state Medicaid agency.
Which Medicare eligible consumer is best suited for a C-SNP?
Who can enroll. To enroll in a Humana C-SNP, you must have Medicare Part A and Part B, and your doctor must verify that you have a qualifying health condition. Common qualifying conditions include end-stage kidney disease (ESKD), diabetes, chronic heart failure and chronic lung disease.
What is the DSNP model of care?
A Dual Special Needs Plan Model of Care (D-SNP MOC) describes how we provide healthcare services to our low-income senior (65+) members and members who have special needs. Our purpose is to provide them with access to care that is reliable, convenient, and accessible.
How many people are dual eligible for Medicare and Medicaid?
They qualify for Medicare because they're at least 65 years old or because they're under age 65 and have a qualifying disability or medical condition. They qualify for Medicaid because they have low income and few resources. In 2024, about 12.8 million Americans are dual-eligible beneficiaries.
What is the difference between QMB and QMB plus?
The only difference between QMB Only and QMB Plus is that QMB Plus beneficiaries also qualify for full Medicaid benefits with their state. The next category is the Specified Low-Income Medicare Beneficiary or SLMB.
Can you have Medicaid and private insurance at the same time in 2024?
The simple answer to the question of “can you have both Medicaid and private insurance?” is a resounding “YES”! Medicaid is given to low-income U.S citizens in need and will not be disputed due to already enrolled in a private health insurance program.
Who are eligible for DSNP?
If you qualify for both Medicare and Medicaid, you most likely qualify for a D-SNP. An easy way to determine if you are dual eligible is to check that you have a Medicare card and a Medicaid card. In general, you must: Be a U.S. citizen or a lawful, permanent resident.
What is the meaning of dual eligibility?
Dual eligibles are individuals who are entitled to Medicare Part A and/or Part B and are eligible for some form of Medicaid benefit.
What are the different types of DSNPS?
Plan Types: Medicare-Medicaid Plans (MMP), Fully Integrated (FIDE SNP), Highly Integrated (HIDE SNP), & Coordination Only (CO) Dual Eligible Special Needs Plans (D-SNPs).
What are the four types of Medicaid?
- State-operated fee-for-service (FFS)
- Primary care case management (PCCM)
- Comprehensive risk-based managed care (MCO model)
- Limited-benefit plans.
Why do some people have both Medicare and Medicaid?
Medicare-Medicaid enrollees include people ages 65 and over who are in relatively good health but have limited financial resources and people who at one time, may have had more financial resources, but spent their income and wealth on health or long-term care costs.
Can you have 2 Medi-Cal insurances at the same time?
Can I have 2 health insurance plans at the same time? Yes. A process called coordination of benefits determines which insurance plan will pay first. Your primary plan will pay for the health claim first, paying the costs up to the plan's coverage limits, and then your second plan will kick in.