The Beginner's Guide to D-SNPs

With the lock-in period in full swing, you’re probably hearing more about Dual Eligible Special Needs Plans (D-SNPs) lately.

Whether you’re new to D-SNPs or searching for information to fine-tune your selling techniques, this quick guide will cover all the basic information you need to know about these valuable, multifaceted products.

What Are D-SNPs?

D-SNPs are a type of Medicare Advantage (MA) Special Needs Plan.

Each state determines which D-SNPs a carrier can offer and the benefits they can include. Generally speaking, D-SNPs include the following:

  • Care coordination
  • $0 monthly premiums
  • Over-the-counter quarterly benefits
  • Dental, vision, and hearing benefits
  • Transportation benefits
  • Gym memberships and wellness programs
  • Telehealth services

The Different Types of D-SNPs

There are three different criteria used to categorize D-SNPs: their network, the Medicaid levels they serve, and their level of integration with Medicaid.

PPO vs. HMO D-SNPs

When categorizing D-SNPs by network, there are two categories: health maintenance organization (HMO) and preferred provider organization (PPO). Most D-SNPs are HMOs.

D-SNPs & Networks

Type of D-SNPDescriptionWho Should Enroll
HMO
  • Requires beneficiaries to use in-network providers for all non-emergency services
  • Requires beneficiaries to elect a primary care physician and receive referrals for specialists
  • Typically associated with lower out-of-pocket (OOP) costs
  • Qualifies for the D-SNP
  • Has access to strong provider networks
  • OK with network restrictions
  • Value lower OOP costs
PPO
  • Has network of providers but will cover beneficiaries for services received out of the network
  • Beneficiaries typically pay more for using out-of-network providers
  • Typically doesn’t require the election of a primary care physician or referrals to see specialists
  • Qualifies for the D-SNP
  • Value a flexible network
  • Willing to spend a little more OOP if needed

Full vs. Partial D-SNPs

There are different types of D-SNPs based on Medicaid levels: Full-Benefit Dual Eligible (FBDE), Medicare Zero Cost Sharing, Dual Eligible Subset, and Dual Eligible Subset Medicare Zero Cost Sharing. Partial D-SNPs may accept individuals who fall into the following Medicaid categories: Medicare Zero Cost Sharing, Dual Eligible Subset, or Dual Eligible Subset Medicare Zero Cost Sharing. The type of enrollees they accept varies based on the plan.

D-SNPs & Medicaid Levels

Type of D-SNPWho Can EnrollEligible Medicaid Categories
FBDE
  • Dual-eligibles who qualify for full Medicaid benefits for the month under any eligibility category or medical assistance for any month if the individual was eligible for assistance in any part of the month
  • Individuals must be enrolled in, or in the process of enrolling in the Medicaid Managed Care Organization (MMCO)
  • FBDE
  • QMB+
  • SLMB+
Medicare Zero Cost SharingDual-eligibles who aren’t responsible for cost-sharing for Medicare Parts A or B
  • QMB
  • QMB+
Dual Eligible SubsetMembers of certain groups of dual-eligibles determined by a carrier’s coordination with a State Medicaid Agency
  • FBDE
  • QMB
  • QMB+
  • SLMB
  • SLMB+
  • QI
  • QDWI
Dual Eligible Subset Medicare Zero Cost SharingMembers of certain groups of dual-eligibles, determined by a carrier’s coordination with a State Medicaid Agency, who aren’t responsible for Medicare cost-sharing
  • FBDE
  • QMB
  • QMB+
  • SLMB
  • SLMB+
  • QI
  • QDWI

Effective January 1, 2027, parent organizations that operate an affiliated Medicaid plan in a region may only offer one FBDE D-SNP there. They may offer additional D-SNPs for partial dual eligibles in that same area.

Integrated vs. Non-Integrated D-SNPs

Some D-SNPs coordinate with their state’s Medicaid program to different extents. Fully integrated D-SNPs (the most integrated option) are affiliated with their state’s MMCO through a single entity that holds both an MA contract with CMS and a MMCO with the applicable state.

Highly integrated D-SNPs are affiliated with their state’s MMCO through:

  • The same MA organization; or
  • The MA organization’s parent organization; or
  • Another entity that is owned and controlled by its parent organization.

Integration facilitates aligned enrollment, where enrollees receive their Medicaid benefits through the D-SNP or affiliated MMCO. Non-integrated D-SNPs are not affiliated with their state’s MMCO.

Some D-SNPs feature exclusively aligned enrollment, only accepting enrollees who receive their Medicaid benefits through the D-SNP or their affiliated MMCO. Exclusively aligned D-SNPs may not enroll partial duals since these individuals are not enrolled in an MMCO.

There are four types of integrated D-SNPs, shown below.

D-SNPs & Medicaid Integration

Type of Integrated D-SNPDescriptionExample
Fully Integrated (FIDE-SNPs)
  • Most integrated D-SNP
  • Single plan entities with capitated contracts to provide both Medicare & Medicaid services
  • Medicaid contracts cover essentially all Medicaid services including long-term services & supports (LTSS)
  • Will all be AIPs by PY2025
  • ABC Health FIDE-SNP provides both Medicare & Medicaid services
Highly Integrated (HIDE-SNPs)
  • Have Medicare and Medicaid contracts either directly or through separate entities under the same parent company
  • Medicaid contracts must cover provision of most Medicaid services, including LTSS or behavioral health but not required to cover both
  • May be an AIP
  • XYZ Health HIDE-SNP provides all Medicare services
  • XYZ Health MMCO provides most Medicaid services
Coordination-Only (CO D-SNPs)
  • Least integrated D-SNP
  • Obligations to coordinate with Medicaid services are very generally defined
  • Must provide notice to the state when member is admitted to a hospital or skilled nursing facility
  • YES Health CO D-SNP provides some care coordination with 123 Health MMCO
  • Beneficiary has a YES Health card and 123 Health MMCO card
Applicable Integrated Plans (AIPs)
  • Features exclusively aligned enrollment
  • Can apply to FIDE-SNPs, HIDE-SNPs, or CO DSNPs
  • Only available to full benefit dual eligibles
  • Potentially ABC Health FIDE-SNP (100% ABC Health in PY2025)
  • Potentially XYZ Health HIDE-SNP
  • Potentially YES Health CO D-SNP

Who Qualifies for D-SNPs?

Dual-eligibles, individuals of any age who are eligible for both Medicare and Medicaid, qualify for D-SNPs.

To be eligible for Medicare, individuals must be 65 years old or older or have a qualifying disability. To be eligible for Medicaid, an individual’s income and asset level must fall below certain thresholds determined by their state.

The type of plan a dual-eligible can enroll in depends upon the Medicaid category they fall under (see D-SNP & Medicaid Levels table) and the plans available in their service area.

Remember, always verify a client’s Medicaid eligibility before enrolling him or her in a D-SNP. Many D-SNP carriers have agent support personnel who can assist you with this task.

Effective 2027, the only individuals who can enroll in D-SNPs with an affiliated Medicaid plan will be full benefit dual eligibles enrolled in, or who are in the process of enrolling in, the D-SNP’s affiliated Medicaid plan. D-SNPs with an affiliated Medicaid plan must disenroll any dual eligible individuals who are not also enrolled in the affiliated Medicaid plan by 2030.

Default Enrollment

An individual may be automatically enrolled into a D-SNP when they are on Medicaid and become newly eligible for Medicare and the individual is in a Medicaid MMCO affiliated with the D-SNP. Individuals must receive a notice of the upcoming enrollment at least 60 days before it will occur and have the opportunity to opt out.

When Can You Sell D-SNPs?

Similar to other MA plans, you can sell D-SNPs to someone in their Initial Coverage Election Period (ICEP), Annual Enrollment Period (AEP), or the Medicare Advantage Open Enrollment Period (MA OEP), if they qualify.

When someone becomes eligible for an integrated D-SNP, they qualify for a Special Enrollment Period (SEP) to join one. As long as they maintain their eligibility for Medicare and Medicaid, they have an SEP to elect an integrated D-SNP once during each month.

D-SNP Election Periods

D-SNP Election PeriodWhat’s Allowed — Contract Year 2024What’s Allowed — Contract Year 2025
ICEPOne change within the three months prior to enrolling in Medicare Parts A and B and either the last day of the month before enrolled in Parts A and B or the last day of the Part B initial enrollment Period, whichever is later One change within the three months prior to enrolling in Medicare Parts A and B and either the last day of the month before enrolled in Parts A and B or the last day of the Part B initial enrollment Period, whichever is later*
AEPOne change between October 15 and December 7One change between October 15 and December 7*
Switching during MA OEPOne allowable change during January 1 and March 31One allowable change during January 1 and March 31*
SEP for electing a FIDE-SNP, HIDE-SNP, or AIP as eligible, mid-yearOne change per quarter except during last quarterOne change per month for full-benefit dual eligibles, only to facilitate aligned enrollment
SEP for electing a non-integrated D-SNP as eligible, mid-yearOne change per quarter except during last quarterNo longer exists

*Exception: Full-benefit dually eligible individuals in Medicaid MCOs can’t select misaligned D-SNPs where applicable

Where Can You Find D-SNP Prospects?

D-SNP prospects are all around you, especially if you work near an urban or generally low-income area. If you sell near a large rural area, it will be more difficult to get prospects because CMS won’t allow D-SNPs in counties that don’t have a certain number of doctors. It will also be difficult to get clients if you do business near moderately to highly wealthy areas, since the type of prospects you’re looking for wouldn’t be able to afford living there.

Since welfare programs and Social Security disburse payments near the beginning of the month, you should be able to attract D-SNP prospects in places where dual-eligibles spend money during the first half of the month. During the second half of the month, you should be able to attract them at places where dual-eligibles seek assistance.

While you cannot scout potential clients, you can host a compliant Medicare educational or sales event or leave compliant promotional materials where D-SNP prospects might go. These actions can help you stand out as a resource in your community for D-SNP prospects to come to you.

First Half of the Month:

  • Dollar stores (e.g., Dollar Tree, Dollar General, and Family Dollar)
  • Discount stores (e.g., Walmart, Ollie’s Bargain Outlet, Price Rite, Big Lots, Ocean State Job Lot, etc.)
  • Thrift shops and flea markets

Second Half of the Month:

  • Food pantries
  • Food banks
  • Soup kitchens

Anytime Throughout the Month:

  • Utility assistance locations
  • Community events (e.g., senior expos and health fairs)
  • Charity events
  • Churches or other faith-based organizations
  • Areas with low-income housing
  • Senior centers
  • Retirement communities

Looking to attract more prospects? Give these strategies for growing your insurance sales territory a try

How Can You Build Your D-SNP Business?

To build your D-SNP book of business, you’ll want to focus your efforts on two main objectives: utilizing grassroots marketing and providing superior customer service.

Utilizing Grassroots Marketing

Taking a grassroots marketing approach is the most effective way to get D-SNP leads and build your D-SNP client base.

Taking a grassroots marketing approach is the most effective way to get D-SNP leads.

Grassroots marketing involves going out into the community where prospective clients are, engaging with them, as well as forming relationships with other professionals in the community who can refer prospective clients to you. Some strategies include:

  • Volunteering at food banks, food pantries, soup kitchens, and charity events
  • Visiting community centers, retirement communities, and areas with low-incoming housing
  • Hanging tear-off flyers or business cards on bulletin boards at indoor flea markets, thrift stores, or churches
  • Forming partnerships with churches, provider offices, non-profit organizations, and retailers
  • Setting up your own booth at community events
  • Holding educational events and sales events

“Position yourself in the community as a resource, and people will come to you.” – A successful D-SNP agent

Note: You MUST follow all CMS Medicare Advantage & Part D Communication Requirements for marketing these plans and holding events. For more information on how to stay compliant, check out our do’s and don’ts of Medicare compliance.

Providing Superior Customer Service

Treating people right will increase your chances of converting prospects into clients, getting referrals from existing clients or professionals within your community, and retaining clients.

You can provide superior customer service by:

How Can You Retain D-SNP Clients?

The fact that dual eligibles may be able to join or switch D-SNPs mid-year can be a double-edged sword. On one hand, it gives you the opportunity to find new MA clients anytime throughout the year. On the other, it gives other agents the opportunity to simultaneously swoop in and steal your clients.

In order to avoid losing your D-SNP clients, ensure you:

  • Establish trust with them. Be someone they know they can come to with health insurance questions.
  • Provide them with superior customer service. Do everything you can to help them (while maintaining a professional relationship) and communicate effectively (in person and digitally).
  • Confirm they’ll know how they can best reach you when they have a question. Give them your phone number and email address. Tip: Fridge magnets are harder to lose than a business card.
  • Follow up with them within the first 30 and 90 days and then every six months to one year. Check how they’re doing, if their income or prescription drug needs have changed, and if they have used the extra benefits (e.g., dental, vision, over the counter).

Taking these measures can help you build client loyalty. Don’t forget, the smallest of actions can make a huge difference in the lives, and minds, of others.

Why Sell D-SNPs?

You’ve learned that selling D-SNPs can earn commissions during Medicare’s off-season, but there’s one point we need to make clear: If you’re only interested in selling these products for your own profit, you may quickly find that you’re not working in the right market.

The dual-eligible population can be difficult to work with. Out in the field, you’ll encounter many people confused by their health insurance options. Your ability to explain things in an easy-to-understand manner and effectively answer questions will be tested. You may even find yourself in houses that make you feel uncomfortable.

Simply put, agents who sell D-SNPs do so because they truly want to help others through their business. You should sell them if you want to do the same.

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Contracting with D-SNPs can open the door to many new opportunities for your business. To learn more about these products or to find out which ones are most competitive near you, send us a message.

Editor’s Note: This article was originally published in January 2017. It has been updated to include information more relevant to 2025.

Not affiliated with or endorsed by Medicare or any government agency.

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