Dual Special Needs Plans (D-SNPs) are specialized health insurance plans designed explicitly for individuals who qualify for both Medicare and Medicaid. They are geared specifically to help people with chronic conditions or disabilities.
Because people with chronic conditions or disabilities often face complex health needs and barriers to accessing care, their needs are more nuanced. D-SNPs give them better access to a more tailored approach to meet those needs.
However, despite their growing popularity and effectiveness, there are still several myths and misconceptions about D-SNPs.
Myth No. 1: D-SNPs are expensive
There are some who assume because these plans are designed for individuals with complex health needs, they must come with high premiums and significant out-of-pocket costs.
Reality: D-SNPs are designed to be affordable for those eligible for both Medicare and Medicaid.
In fact, many D-SNPs have low or even no premiums, and they often include reduced out-of-pocket costs compared to original Medicare. They can also offer cost-sharing assistance, which further helps beneficiaries save on health care expenses.
“With a D-SNP plan, a member will have little to no out-of-pocket expenses for covered medical services — no deductibles, coinsurance or copayments,” said John Cole, CEO of Shared Health, a health insurance company with a new plan available in Houston. “If someone qualifies for a D-SNP plan, they can enroll to take advantage of these cost savings, reducing their overall health care costs.”
The goal is to make comprehensive health care more accessible and affordable for people with limited income and high health care needs.
Myth No. 2: D-SNPs don’t provide comprehensive coverage
Another misconception is that D-SNPs offer limited coverage, or that they provide fewer benefits than traditional Medicare.
Reality: On the contrary, D-SNPs often provide more comprehensive coverage than original Medicare alone. In addition to the standard Medicare benefits, D-SNPs typically include extra benefits that help meet the diverse needs of dual-eligible individuals. These can include coverage for dental care, vision care, hearing aids, transportation services and even fitness programs or meal services. These additional benefits aim to improve overall health and quality of life, and address needs that go beyond basic medical care.
Myth No. 3: D-SNPs are complicated and difficult to manage
Some individuals worry that D-SNPs are difficult to navigate, or that the process of managing healthcare under such a plan is confusing and overwhelming.
Reality: Many D-SNPs offer care coordinators who can help members understand and manage their benefits.
“Each member is contacted by their own Personal Assistance Liaison (PAL), who outlines how they can assist with the member’s health journey,” Cole said.
These professionals work closely with beneficiaries to ensure they get the care they need, answer questions about coverage and help connect them to necessary resources. In addition to personalized care coordination, many D-SNP providers offer customer support services and online tools that make managing health care easier. These services are designed to help enrollees stay informed and in control of their health care decisions.
“Whether it’s scheduling appointments, finding in-network providers or answering questions about benefits, PALs are there to support members every step of the way along their health care journey,” Cole said. “This level of personalized care and support distinguishes our plans and ensures our members receive the comprehensive care they deserve.”
Myth No. 4: Only very sick individuals qualify for D-SNPs
Some people believe that D-SNPs are only for those who are severely ill or have complex medical conditions. This myth may discourage individuals who could benefit from D-SNPs but don’t perceive themselves as “sick enough” to qualify.
Reality: D-SNPs are for individuals who qualify for both Medicare and Medicaid, regardless of their overall health status. While many individuals who are enrolled in D-SNPs may have complex or chronic health conditions, eligibility is not based solely on health.
“To qualify for Medicare, individuals must be 65 years or older, or under 65 with certain disabilities. Medicaid eligibility is based on income and resource limits, which vary by state,” Cole said. “Dual-eligible individuals meet the criteria for both programs, making them eligible for D-SNPs. This dual eligibility ensures members receive the full spectrum of benefits from both Medicare and Medicaid, along with the additional services provided by our D-SNP plans.”
Myth No. 5: Switching to a D-SNP will disrupt existing care
Another common concern is that enrolling in a D-SNP will cause disruption to a beneficiary’s existing health care provider relationships. People worry that they will have to change doctors or face challenges with continuity of care.
Reality: The ability to retain your current doctor depends on the type of D-SNP plan you choose, but many of them work closely with local providers and have established networks of health care professionals who are familiar with the needs of dual-eligible individuals.
“Shared Health Dual Freedom is a PPO D-SNP plan that allows members to see doctors outside of our network,” Cole said. “This means you can continue seeing your trusted doctor. Your doctor would just need to file a claim with Shared Health if they’re out-of-network.”
These plans often prioritize continuity of care, meaning they strive to maintain access to existing health care providers when possible.
“It ensures continuity of care and allows members to maintain the trust and rapport they have built with their doctors,” Cole said. “Our goal is to make the transition to a D-SNP plan as seamless as possible, without disrupting the care members are accustomed to.”
Making an informed choice for health care
Understanding the facts about D-SNPs can help individuals make informed decisions about their health care and take full advantage of the benefits available to them.
“For those eligible for both Medicare and Medicaid, enrolling in a D-SNP plan is highly advantageous,” Cole said. “These plans offer additional benefits beyond standard Medicare and Medicaid.”
D-SNPs are affordable, comprehensive, easy to manage, accessible to a wide range of beneficiaries and focused on ensuring continuity of care.
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