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How to know if you qualify for a D-SNP
Find out if you are eligible for both Medicare and Medicaid and a Dual Eligible Special Needs Plan, or D-SNP, and the additional benefits and support that come with it.
If you’re eligible for both Medicare and Medicaid, you may qualify for a Dual Eligible Special Needs Plan (D-SNP). The additional benefits and care that come with a D-SNP can make it easier and more affordable to make your health a priority. D-SNPs help you stay on top of checkups, screenings and managing any health conditions. But only certain people qualify for a D-SNP. And the rules for eligibility can be confusing.
If you have questions about D-SNP eligibility, help is here! Keep reading to the four things you need to qualify for a D-SNP. Plus, find ways to make it easier to check your eligibility and get enrolled in the right D-SNP for you.
1. You must qualify for Medicare
Medicare is a federal health insurance plan. It’s for anyone who is 65 or older. You may be able to get Medicare before your 65th birthday if you have any of the following:*
- A disability. You become eligible after receiving Social Security Disability Insurance (SSDI) payments for 24 months.*
- End-stage renal disease. (This is permanent kidney failure that requires dialysis or a transplant.)
- Amyotrophic lateral sclerosis (ALS). It’s also known as Lou Gehrig’s disease.
2. You must qualify for Medicaid
Medicaid provides health coverage to millions of Americans who can’t afford it on their own. To be fully eligible for Medicaid, you need to be at least at the federal poverty level (FPL).* The income limit for the FPL changes each year. For example, the income limit for a single person in 2023 is $13,590. In 2024, the limit is $14,580.
However, each state can decide who is eligible for Medicaid, says Michelle Katz, LPN, MSN, a health care advocate in the Washington, D.C., area. And 41 states have expanded their Medicaid coverage to allow more people to qualify. In those states, you qualify for Medicaid coverage if your household income is up to 138 percent of the federal poverty level.
So what does that look like in real numbers? In 2024, if your income falls within the range indicated for your family size below, there’s a good chance you qualify for Medicaid:*
- Individual: $14,580–$20,120
- Family of two: $19,720–$27,213
- Family of three: $24,860–$34,306
- Family of four: $30,000–$41,400
- Family of five: $35,140–$48,493
- Family of six: $40,280–$55,586
- Family of seven: $45,420–$62,679
- Family of eight: $50,560–$69,772
- Families of nine or more: Add $5,140 for each additional person.
The 10 states that have not adopted Medicaid expansion are:
1 Alabama
2 Florida
3 Georgia
4 Kansas
5 Mississippi
6 South Carolina
7 South Dakota
8 Tennessee
9 Texas
10 Wyoming
That means that in those states, you must be at the FPL to qualify for Medicaid.*
You can also be partially eligible for Medicaid. This means that you qualify for a Medicare Savings Program (MSP). MSPs are managed by a state’s Medicaid program. They cover certain costs, like part B premiums. But they don’t provide full Medicaid benefits. Still, if you have partial dual eligibility, you may also qualify for a D-SNP, says Katz. You just may have to pay some out-of-pocket costs.
One of the easiest ways to find out if you qualify for Medicaid or a D-SNP? Talk to a licensed agent. A licensed Aetna® agent can confirm your eligibility and answer all your D-SNP questions for free.
Checking your D-SNP eligibility just got a lot easier
A licensed Aetna® agent can check your eligibility and guide you through the enrollment process — for free. Schedule a call with a licensed Aetna® representative today — it can’t hurt to learn more.
3. You must live in a D-SNP service area
Each year, different health plans offer D-SNPs in different parts of the country. The insurance companies decide where they will do business. They may also offer more than one plan in an area, with different benefits.
Here are some ways to find a Medicare D-SNP in your area:*
- Call a licensed agent.
- Check out the website of the health plan you're interested in. For example, Aetna has a free online tool for searching for plans. The tool makes it easy to find and compare plans in your area. All you need is your ZIP code to start.
- Look at the "Medicare & You" handbook. It's mailed to you each year from the U.S. government. The handbook lists Medicare SNPs in your area.
4. Be a U.S. citizen or a lawful permanent resident
To qualify for a D-SNP, you must be an American citizen. Or you must be a legal resident who has lived in the United States for at least five years in a row.
Remember: If you need help to find out if you qualify for a D-SNP, an Aetna agent is here for you. They can confirm your eligibility and help you through the enrollment process at no charge to you.
Want to learn more about D-SNPs and becoming a member? Check out these related articles and resources to get answers and support:
Aetna® is a recipient of the Newsweek America’s Best Customer Service Award for 2023.*
*FOR MEDICARE ELIGIBILITY AND PARTS: U.S. Department of Health and Human Services. “Who’s eligible for Medicare?” August 31, 2023. Accessed <July 24, 2023>.
*FOR INCOME RANGE AND MEDICAID ELIGIBILITY: Kaiser Family Foundation. “Medicaid income eligibility limits for adults as a percent of the federal poverty level.” January 1, 2023. Accessed July 23, 2023.
*FOR LOCATING D-SNP SERVICE AREAS: Centers for Medicare and Medicaid services. “Your guide to Medicare Special Needs Plans (SNPs).” Accessed <July 23, 2023>.
*FOR NEWSWEEK AWARD: The 2023 Newsweek America’s Best Customer Service rankings were identified from the results of an independent survey of more than 30,000 U.S. customers who have either made purchases, used services, or gathered information about products or services in the past three years. Customers evaluated several brands: In total, over 200,000 evaluations were collected. The awarded brands each received on average 100 evaluations from customers. For more information, visit https://www.newsweek.com/rankings/americas-best-customer-service-2023
Plan features and availability may vary by service area.
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