Dual Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual’s eligibility.
Medicaid Eligibility Categories
The Medicaid eligibility categories encompass all categories of Medicaid eligibility including:
- Full Medicaid (only);
- Qualified Medicare Beneficiary without other Medicaid (QMB Only);
- QMB Plus;
- Specified Low-Income Medicare Beneficiary without other Medicaid (SLMB Only);
- SLMB Plus;
- Qualifying Individual (QI); and
- Qualified Disabled and Working Individual (QDWI).
States may vary in determining their eligibility categories; therefore, there may be state-specific differences in the eligibility levels in comparison to those listed here. For specific information regarding Medicaid eligibility categories, refer to the Medicaid website.
NOTE: CMS no longer categorizes D-SNPs by subtype (see the below link to the December 7, 2015, HPMS memo “Discontinuation of Dual Eligible Special Needs Plans Sub-type Categories”).
D-SNPs With or Without Medicare Zero-Dollar Cost Sharing
At the time of plan creation, each D-SNP must identify whether or not if offers Medicare zero-dollar cost sharing. In HPMS, D-SNPs will have the option of one of the following two indicators:
- Medicare Zero-Dollar Cost Sharing Plan, or
- Medicare Non-Zero Dollar Cost Sharing Plan.
These two indicators will be used in multiple areas within HPMS and are essential to the proper display of benefits in Medicare Plan Finder.