A D-SNP offers affordable Medicare Advantage benefits to Medicaid members — learn more here now
No one should have to choose between having trustworthy health insurance and putting healthy food on the table. Unfortunately, it’s a common struggle for many Americans. If you’re one of them, you may be able to get help from a Dual Eligible Special Needs Plan, or D-SNP.
A Dual Eligible Special Needs Plan is a type of health insurance plan designed for individuals who are eligible for both Medicare and Medicaid. People who qualify for a D-SNP are “dual eligible.” They tend to have greater health care needs than others.
That's why D-SNPs offer additional coverage from other Medicare plans. For example, Aetna® offers D-SNPs that include dental, vision and hearing coverage. Aetna D-SNPs also give members an allowance to help pay for certain everyday expenses. And all Aetna D-SNP members get prescription drug coverage. The overall goal of a D-SNP: to deliver quality and efficient care at a low or no cost.
D-SNPs are available in 45 states and Washington, D.C. About 3.8 million Americans already have one.* Want to learn more about D-SNPs? Here’s a closer look.
D-SNPs offer affordable Medicare Advantage benefits for members with Medicaid.
Medicare is a federal health insurance program that primarily covers individuals age 65 and older, as well as some younger individuals with disabilities. A Medicare Advantage plan includes two parts:*
1. Medicare Part A and B (hospital insurance and medical insurance).
Part A covers:
Part B covers:
Aetna® care teams can help you find a doctor, schedule appointments, manage a condition, access the right benefits and more. It’s a personal benefit designed for Aetna Dual Eligible Special Needs Plan members.
2. Medicare Part D (Drug coverage). Part D covers the cost of prescription drugs as well as certain shots or vaccines.
Medicaid is a joint federal and state program. It provides health coverage to people with low incomes, disabilities or certain illnesses. With a D-SNP, Medicaid provides coverage to help pay for premiums, cost sharing and services not covered by Medicare.*
All D-SNPs are different, but they all offer additional coverage and benefits you wouldn’t normally get with a health plan. Aetna D-SNPs come with:
A dedicated care team. Care teams help you understand your benefits, coordinate doctor visits, manage your medicines and more. They help take the stress out of getting the care you need and deserve. And they work to save you time and money along the way.
Dental, vision and hearing coverage. Many Medicare and Medicaid plans can have dental, vision and hearing coverage. But Aetna offers D-SNPs that include more coverage for dental, vision and hearing.
A $0 copay on covered Part D prescription drugs at in-network pharmacies.
All D-SNPs include our Extra Benefits Card with an allowance that can be used for approved over-the-counter (OTC) products.
Depending on your plan and eligibility, you may be able to use your card for certain everyday expenses, like:
*Members in California, New Jersey and New York FIDE plans must have a qualifying condition to be eligible for this benefit.
**Members in New Jersey and New York FIDE plans must have a qualifying condition to be eligible for this benefit. Members in California plans are not eligible for this benefit.
For members in California, New Jersey and New York FIDE plans: 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.
If you have questions, call us at 1-833-228-1297 (TTY: 711) 7 days a week, 8 AM to 8 PM.
A licensed Aetna agent will answer the call and can answer your questions for free.
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.
To qualify for a D-SNP, you must be eligible for both Medicare and Medicaid. If you’re worried that switching to a D-SNP may cause you to lose your Medicaid coverage, rest easy: It won’t.
One of the easiest ways to find out if you qualify for a D-SNP? Talk to a licensed agent. A licensed Aetna agent can confirm your eligibility. And they can answer your D-SNP questions for free.
If you're eligible, here’s how to apply for dual Medicare and Medicaid, or a D-SNP. The first step is to compare D-SNPs in your area based on cost, coverage and benefits, to find the right one for you. A licensed agent can be super helpful with this, too.
Another good idea is to check out the website of the health plan you're interested in. For example, Aetna has a free online tool that makes it easy to search for plans in your area. All you need is your ZIP code to get started.
Timing is also important. There are four times when you can enroll in a D-SNP.
Initial Enrollment Period: This enrollment period is only available when you first become eligible for Medicare. It starts three months before your 65th birthday and continues for seven months.
Annual Enrollment Period: 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. Additionally, a SEP is available three months after you begin Medicaid coverage. And 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. To check your eligibility for a SEP, call a licensed Aetna agent at 1-833-228-1297 (TTY: 711) 7 days a week, 8 AM to 8 PM.
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 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.
If you have more questions about D-SNPs or need support with enrollment, you don't have to figure it out alone. Remember, a licensed Aetna agent can help you find the best Aetna plan for you. They can help you join when the time is right and complete the enrollment process. They'll also be there for future questions.
And that support doesn’t go away once you become a member. Aetna D-SNP members can call their care team for help coordinating their care. In addition, the Aetna Member Services team is available from 8 AM to 8 PM, 7 days a week. Plus, Aetna members can call the 24/7 Nurse Line to get answers to health questions from a registered nurse.
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 D-SNP MEMBERSHIP: Medicaid and CHIP Payment and Access Commission. Medicare Advantage dual eligible special needs plans. Accessed September 20, 2024.
* FOR PARTS OF MEDICARE: Medicare.gov. Parts of Medicare. Accessed September 20, 2024.
* FOR MEDICAID COVERAGE: Kaiser Family Foundation. 10 Things to Know About Medicaid. June 30, 2023. Accessed September 20, 2024.
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.
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.
The formulary and/or pharmacy network may change at any time. You will receive notice when necessary.
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 members in California, New Jersey and New York FIDE plans: 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. If you have questions, call us at 1-833-228-1297 (TTY: 711) 7 days a week, 8 AM to 8 PM.
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).
Plan features and availability may vary by service area. For accommodation of persons with special needs at meetings, call 1-833-278-3924 (TTY: 711).
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. Member name(s) and other details have been omitted or fictionalized to protect the member’s (members’) identity(ies). For more information about Aetna plans, refer to our website.
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