If you’re eligible for both Medicare and Medicaid, you may qualify for a Dual Eligible Special Needs Plan (D-SNP). The additional benefits and care that come with a D-SNP can make it easier and more affordable to make your health a priority. D-SNPs help you stay on top of checkups, screenings and managing any health conditions. But only certain people qualify for a D-SNP. And the rules for eligibility can be confusing. 

If you have questions about D-SNP eligibility, help is here! Keep reading for the four things you need to qualify for a D-SNP. Plus, find ways to make it easier to check your eligibility and enroll in the right D-SNP for you. 

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Talk to a licensed agent today — it doesn’t cost a thing to learn more about Aetna® Dual Eligible Special Needs Plans!

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1. You must qualify for Medicare 

Medicare is a federal health insurance plan. It’s for anyone who is 65 or older. You may be able to get Medicare before your 65th birthday if you have any of the following:* 

• A disability. You become eligible after receiving Social Security Disability Insurance (SSDI) payments for 24 months.* 

• End-stage renal disease. (This is permanent kidney failure that requires dialysis or a transplant.) 
   
• Amyotrophic lateral sclerosis (ALS). It’s also known as Lou Gehrig’s disease.   

2. You must qualify for Medicaid 

Medicaid provides health coverage to millions of Americans who can’t afford it on their own. To be fully eligible for Medicaid, you need to be at least or below the federal poverty level (FPL).* The income limit for the FPL changes each year. For example, the income limit for a single person in 2024 is $15,060.

However, each state can decide who is eligible for Medicaid, says Michelle Katz, LPN, MSN, a health care advocate in the Washington, D.C. area. And 41 states have expanded their Medicaid coverage to allow more people to qualify. In those states, you qualify for Medicaid coverage if your household income is up to 138 percent of the federal poverty level. 

So what does that look like in real numbers? In 2024, if your income falls within the range indicated for your family size below, there’s a good chance you qualify for Medicaid:* 

• Individual: $14,580–$20,120
   
• Family of two: $19,720–$27,213 

• Family of three: $24,860–$34,306 
   
• Family of four: $30,000–$41,400 
   
• Family of five: $35,140–$48,493 
   
• Family of six: $40,280–$55,586 
   
• Family of seven: $45,420–$62,679 

• Family of eight: $50,560–$69,772 
   
• Families of nine or more: Add $5,140 for each additional person. 

The 10 states that have not adopted Medicaid expansion are:  

1. Alabama 
    
2. Florida 
    
3. Georgia 
    
4. Kansas 
    
5. Mississippi 
    
6. South Carolina 
    
7. South Dakota 
    
8. Tennessee 
    
9. Texas 
    
10. Wyoming 

That means that in those states, you must be at the FPL to qualify for Medicaid.* 

Get help paying for things to help you stay well

Aetna Dual Eligible Special Needs Plan, or D-SNP, members get an Extra Benefits Card with a monthly allowance  they can use to help pay for certain everyday expenses like over-the counter (OTC) products.

To see if an Aetna Dual Eligible Special Needs Plan, or D-SNP, is right for you, call us at 1-833-228-1297 (TTY: 711) between 8 AM and 8 PM, 7 days a week.

You can also be partially eligible for Medicaid. This means that you qualify for a Medicare Savings Program (MSP). A state's Medicaid program manages its MSPs. They cover certain costs, like part B premiums. But they don’t provide full Medicaid benefits. Still, if you have partial dual eligibility, you may also qualify for a D-SNP, says Katz. You just may have to pay some out-of-pocket costs. 

One of the easiest ways to find out if you qualify for Medicaid or a D-SNP? Talk to a licensed agent. A licensed Aetna® agent can confirm your eligibility and answer all your D-SNP questions for free.  

3. You must live in a D-SNP service area 

Each year, different health plans offer D-SNPs in different parts of the country. The insurance companies decide where they will do business. They may also offer more than one plan in an area, with different benefits.  

Here are some ways to find a Medicare D-SNP in your area:* 

• Call a licensed agent. 
   
• Check out the website of the health plan you’re interested in. For example, Aetna has a free online tool for searching for plans. The tool makes it easy to find and compare plans in your area. All you need is your ZIP code to start. 

• Look at the "Medicare & You" handbook. It's mailed to you each year from the U.S. government. The handbook lists Medicare SNPs in your area. 

4. Be a U.S. citizen or a lawful permanent resident 

To qualify for a D-SNP, you must be an American citizen. Or you must be a legal resident who has lived in the United States for at least five years in a row. 

Remember: If you need help to find out if you qualify for a D-SNP, an Aetna agent is here for you. They can confirm your eligibility and help you through the enrollment process at no charge to you. 

It’s here — health care you can rely on

To see if an Aetna Dual Eligible Special Needs Plan, or D-SNP, plan is right for you, call us at 1-833-228-1297 (TTY: 711) between 8 AM and 8 PM, 7 days a week.

If you qualify for both Medicare and Medicaid, you may be eligible for an Aetna Dual Eligible Special Needs Plan (D-SNP).

If you're 65 or older and have diabetes or an eligible heart disease, you may qualify for an Aetna Chronic Condition Special Needs Plan (C-SNP). C-SNPs are currently available in select counties in IL and PA.  

You may be eligible for an Institutional Special Needs Plan (I-SNP) if you’ve lived (or plan to live) in a participating facility for 90+ days or you have Medicare Part A (hospital insurance) and Part B (medical insurance).

*FOR MEDICARE ELIGIBILITY AND PARTS: U.S. Department of Health and Human Services. Who’s eligible for Medicare? August 31, 2023. Accessed October 26, 2024. 

*FOR INCOME RANGE AND MEDICAID ELIGIBILITY: Kaiser Family Foundation. Medicaid income eligibility limits for adults as a percent of the federal poverty level. January 1, 2023. Accessed October 26, 2024. 

*FOR LOCATING D-SNP SERVICE AREAS: Centers for Medicare and Medicaid services. Your guide to Medicare Special Needs Plans (SNPs). Accessed October 26, 2024.

Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our DSNPs also have contracts with state Medicaid programs. Enrollment in our plans depends on contract renewal.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

Participating health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.

For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 14 days. You can call the phone number on your member ID card if you do not receive your mail-order drugs within this timeframe. Members may have the option to sign-up for automated mail-order delivery.

To send a complaint to Aetna, call the plan or the number on your member ID card. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week. If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.  

For accommodation of persons with special needs at meetings, call 1-833-278-3924 (TTY: 711).

The benefits mentioned are part of special supplemental program for the chronically ill. Eligibility is determined by whether you have a chronic condition associated with this benefit. Standards may vary for each benefit. Conditions include Hypertension, Hyperlipidemia, Diabetes, Cardiovascular Disorders, Cancer. Other eligible conditions may apply. Contact us to confirm your eligibility for these benefits. Eligibility for the Model Benefit or Reward and Incentive (RI) Programs under the Value-Based Insurance Design (VBID) Model is not assured and will be determined by Aetna after enrollment, based on relevant criteria (e.g., clinical diagnoses, eligibility criteria, participation in a disease state management program).

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