🔎 What is a D-SNP?

🤔 Who Qualifies for a D-SNP?

To qualify for a D-SNP, you must:

• Enroll in Medicare Part A and Part B.
• Be eligible for Medicaid through your state.

Then, if you meet both, you may qualify to enroll in a D-SNP that serves your area.

💼 What Does a D-SNP Do?
Special Needs plans provide all the coverage of Original Medicare, plus:

• Prescription drug coverage (Part D) built into the plan.
• Extra benefits like dental, vision, hearing, and transportation, depending on the plan potentially grocery, utility and rent assistance.
• Care coordination services to help you manage your healthcare.

Key Features and Benefits:

Integrated Care Coordination:

D-SNPs provide a coordinated approach to healthcare by aligning Medicare and Medicaid benefits, which helps reduce gaps in care and eliminates the confusion that can arise when managing two separate programs. This coordination often involves case management, personalized care planning, and support from a team of healthcare professionals who understand the member’s full range of health and social needs.

Comprehensive Coverage:

In addition to covering the standard Medicare benefits (Part A hospital insurance, Part B medical insurance, and often Part D prescription drug coverage), DSNPs include Medicaid-covered services such as long-term care, personal care services, and sometimes transportation or home health aides, depending on the state’s Medicaid program.

Lower Out-of-Pocket Costs:

Because Medicaid assists with many out-of-pocket expenses like premiums, copayments, and deductibles, members of D-SNPs typically experience lower overall healthcare costs compared to traditional Medicare Advantage plans. Thus, this financial protection is crucial for individuals with limited income and high medical needs.

Additional Benefits and Support Services:

Many D-SNPs offer enhanced benefits beyond what traditional Medicare or Medicaid cover, such as dental and vision care, hearing aids, wellness programs, and social support services. These extras aim to improve quality of life and help members maintain independence.

Focus on Chronic Conditions and Complex Care Needs:

Dual eligibles often have multiple chronic conditions or disabilities that require ongoing medical attention and coordination across providers. Therefore, D-SNPs specialize in managing these complexities by providing tailored care programs, medication management, and regular health assessments.

State and Plan Variations:

Because Medicaid is state-administered, the exact benefits, eligibility criteria, and service coordination models can vary by state and by specific D-SNPs. Plans must work within federal guidelines but adapt to local Medicaid rules, which affects how benefits are delivered.

Eligibility and Enrollment:

To enroll in a D-SNP, an individual must be eligible for both Medicare (usually due to age 65+ or qualifying disability) and Medicaid. Enrollment periods may be limited, but there are often special enrollment options to ensure dual eligibles can join or switch plans when needed.

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🌐 Illinois MMP Transition to D-SNPs

Illinois has been offering Medicare-Medicaid Plans (MMPs) for individuals who have both Medicare and Medicaid. These MMPs will be sunsetted on December 31st of 2025.
Starting January 1st, 2026, new D-SNP plans will be introduced in Illinois to replace MMPs. This transition is important for anyone currently in an MMP—you’ll need to choose a D-SNP to continue receiving coordinated Medicare and Medicaid benefits in 2026.

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🚀 Special Enrollment Period (SEP) for Duals
If you have both Medicare and Medicaid, you are entitled to a Special Enrollment Period (SEP) every month. That means:

• You can switch to a different D-SNP at any time during the year.
• Important: Your Medicaid coverage must be through the same company as your D-SNP plan for you to enroll.

This SEP gives you flexibility to find the plan that best fits your needs.

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💬 Need Help Choosing a D-SNP?
At Thompson Medicare Brokerage, I can help you:

• Understand your eligibility.
• Compare D-SNP plans in your area.
• Make the transition from an Illinois MMP to a D-SNP smoothly.

Contact us today to review your options and make sure you’re ready for 2026!

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✅ Moving forward..

Medicare isn’t just about picking a plan — it’s about having someone in your corner who puts your needs first. At Thompson Medicare Brokerage, I believe in full transparency and real guidance. My role isn’t to steer you toward the plan that pays me more — it’s to help you find the one that fits your health, lifestyle, and budget best.

Whether you’re navigating Medicare Advantage, Medigap, VA coordination, or Medicaid overlap, I’m here for you year-round — not just during enrollment. I’ll help you check your doctors, prescriptions, and benefits so you can make confident, informed decisions.

Still comparing options? Feel free to explore more of my Medicare articles or visit the Broker Services page to learn how I support clients before, during, and after they enroll.

And when you’re ready to have a real conversation, let’s connect. I’ll take the time to understand your full picture — so we can choose a plan that supports your peace of mind, not just your paperwork.