Your top questions about Dual Eligible Special Needs Plans (D-SNPs), answered
Get answers to frequently asked questions about D-SNPs
Thinking about enrolling in a Dual Eligible Special Needs Plan, or D-SNP, but still have a few questions? Good! It’s wise to work through your concerns now so you can make the best possible decisions for your health and well-being. And we’re here to help you get the information you’re seeking. Keep reading for answers to top questions about Aetna plans.
What is a D-SNP?
D-SNPs are low- to no-cost health insurance plans.
D-SNP members get both Medicare and Medicaid benefits. On top of that, D-SNPs offer added coverage and benefits than Original Medicare. They're designed to help members overcome common roadblocks to well-being, such as lack of access to healthy foods or reliable transportation.
Get the support of a personal care team
Aetna® care teams are here to help manage your care and connect you with the health and community services you may need.
What do D-SNPs cover?
With a D-SNP, you get the benefits of a Medicare Advantage plan together with your Medicaid coverage. With both plans, you could get additional complete medical coverage.
That said, every D-SNP is different — so be sure to check coverage in your area. For instance, Aetna® offers D-SNPs that include benefits well beyond medical coverage, such as:
- A dedicated care team to help you manage your care, get the health and community resources you may need and more
- Dental, vision and hearing coverage
- Prescription drug coverage, including $0 copays on covered Tier 1 and Tier 2 prescription drugs at in-network pharmacies
Aetna D-SNP members get a monthly allowance on an Extra Benefits Card to pay for certain over-the-counter (OTC) products. Member with a qualifying chronic condition who meet all other criteria can use the monthly allowance to help pay for additional everyday expenses, including certain:
- Healthy foods
- Personal care products
- Transportation
- Utilities
What does “dual eligible” mean and how do you qualify?
Dual eligible means that you meet the requirements for both Medicare and Medicaid assistance. You must be enrolled in both to become a D-SNP member.
Can I still see my provider if I enroll?
As long as your provider is in network. You can check before you enroll. A licensed agent can help you look up your provider. Plans also have provider directories on their websites. Plus, Aetna has a free online tool that lets you search for in-network providers and plans in your area.
Will being a member change the way I get care?
No — and it may even get better! Aetna plan networks include care providers that are dedicated to your health and well-being. Plus, the added benefits and services that come with an Aetna plan make it easier to get the care and support you need to feel your best.
Will I lose my Medicaid benefits?
No, you won’t lose your Medicaid benefits. In fact, you must qualify for a Medicaid program to enroll in a D-SNP. So, access to your Medicaid benefits will continue.
How much does a plan cost?
D-SNPs are low- to no-cost health plans with a goal of helping you save money while getting quality care. For instance, Aetna offers plans that include dental, vision and hearing coverage, as well as prescription drug coverage, at no additional cost. Plus, they include monthly allowances to help you pay for certain over-the-counter (OTC) products that can help you stay well.
When can I enroll?
You can enroll at four different times. Here are the enrollment periods you should know about:
Initial Enrollment Period: This enrollment period is only available when you first become eligible for Medicare. Your IEP is the seven-month period that begins three months before your 65th birthday, includes your birthday month and ends three months afterward. There is an exception: If your birthday falls on the first of any month, your seven-month IEP begins and ends one month sooner.
Annual Enrollment Period (AEP): The Annual Enrollment Period for health insurance plans runs every year from October 15 to December 7. During this time, you can pick a new D-SNP (or any Medicare Advantage plan), switch from Original Medicare to Medicare Advantage, or change your Part D coverage.
Open Enrollment Period (OEP): This occurs annually from January 1 to March 31. It allows beneficiaries who are already enrolled in a Medicare Advantage plan to make certain changes to their coverage.
Special Enrollment Period (SEP): There may be other times when you can enroll in a D-SNP. This can include if you move, or if there’s a disaster declared by FEMA. A SEP is also available three months after you begin Medicaid coverage. Plus, a SEP is available for Full Benefit Dual Eligible (FBDE) individuals to align Medicaid and Medicare coverage, so they’re provided by the same insurance company.
Aetna Medicare is an HMO, PPO plan with a Medicare contract. Our DSNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.
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.
This material is for informational purposes only and is not medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Contact a health care professional with any questions or concerns about specific health care needs. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to our website.
The Aetna C-SNP is available to Medicare members who have at least one of the qualifying chronic conditions. To ensure a successful enrollment process, we’ll confirm with your healthcare provider that you have one of these eligible conditions. If verification of eligible condition is not received, involuntary disenrollment will occur.
The benefit(s) mentioned are part of special supplemental benefits for the chronically ill (SSBCI). SSBCI conditions include certain cardiovascular disorders, chronic heart failure, and diabetes. Eligibility is determined by whether you have a chronic condition associated with the benefit(s) and you meet all other criteria. Even if you have a listed chronic condition, you may not necessarily receive the benefit because other eligibility and coverage criteria may apply. Standards and conditions vary for each benefit. Contact us to confirm the specific SSBCI condition requirements for the benefit(s) for this plan and determine your eligibility.
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 10 days. You can call the number on the back of you 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).
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