Get answers to frequently asked questions about D-SNPs
Thinking about enrolling in a Dual Eligible Special Needs Plan, or D-SNP, but still have a few questions? Good! It’s wise to work through your concerns now so you can make the best possible decisions for your health and well-being. And we’re to help you get the information you’re seeking. Keep reading for answers to top questions about D-SNPs.
D-SNPs are low- to no-cost health insurance plans.
D-SNP members get both Medicare and Medicaid benefits. On top of that, D-SNPs offer more coverage and benefits than Original Medicare. They're designed to help members overcome common roadblocks to well-being, such as lack of access to healthy foods or reliable transportation.
Aetna® care teams can help you find a doctor, schedule appointments, manage a condition, access the right benefits and more. It’s a personal benefit designed for Aetna Dual Eligible Special Needs Plan members.
With a D-SNP, members get the benefits of a Medicare Advantage plan and we work together with your Medicaid coverage. With both plans, you could get more complete medical coverage.
That said, every D-SNP is different, so be sure to check coverage in your area. For instance, Aetna® offers D-SNPs that include benefits well beyond medical coverage, such as:
Depending on your plan and eligibility, you may be able to use your card for certain everyday expenses, like:
• Healthy foods*
• Utilities**
• Gas or transportation**
• Personal care products**
*Members in California, New Jersey and New York FIDE plans must have a qualifying condition to be eligible for this benefit.
**Members in New Jersey and New York FIDE plans must have a qualifying condition to be eligible for this benefit. Members in California plans are not eligible for this benefit.
For members in California, New Jersey and New York FIDE plans: The benefits mentioned are part of special supplemental program for the chronically ill. Eligibility is determined by whether you have a chronic condition associated with this benefit. Standards may vary for each benefit. Conditions include hypertension, hyperlipidemia, diabetes, cardiovascular disorders, cancer. Other eligible conditions may apply. Contact us to confirm your eligibility for these benefits.
If you have questions, call us at 1-833-228-1297 (TTY: 711) 7 days a week, 8 AM to 8 PM.
Dual eligible means that you meet the requirements for both Medicare and Medicaid assistance. You must be enrolled in both to become a D-SNP member.
As long as your provider is in-network. You can check before you enroll. A licensed agent can help you look up your provider. Plans also have provider directories on their websites. Plus, Aetna has a free online tool that lets you search for in-network providers and D-SNP plans in your area.
No — and it may even get better! Aetna D-SNP networks include care providers that are dedicated to your health and well-being. Plus, the added benefits and services that come with an Aetna D-SNP make it easier to get the care and support you need to feel your best.
No, you won’t lose your Medicaid benefits. In fact, you must qualify for a Medicaid program to enroll in a D-SNP. So access to your Medicaid benefits will continue.
D-SNPs are low- to no-cost health plans with a goal of helping you save money while getting quality care. For instance, Aetna offers D-SNPs that include dental, vision and hearing coverage as well as prescription drug coverage at no additional cost. Plus, Aetna D-SNPs include monthly allowances to help you pay for everyday items that help you stay well.
You can enroll in a D-SNP at four different times. Here are the enrollment periods you should know about:
Initial Enrollment Period: This enrollment period is only available when you first become eligible for Medicare. It starts three months before your 65th birthday and continues for seven months. If your birthday is on the first of the month, eligibility starts two months before you turn 65.
Annual Enrollment Period (AEP): The Annual Enrollment Period for health insurance plans runs every year from October 15 to December 7. During this time, you can pick a new D-SNP (or any Medicare Advantage plan), switch from Original Medicare to Medicare Advantage, or change your Part D coverage.
Open Enrollment Period (OEP): This occurs annually from January 1 to March 31. It allows beneficiaries who are already enrolled in a Medicare Advantage plan to make certain changes to their coverage.
Special Enrollment Period (SEP): There may be other times when you can enroll in a D-SNP. This can include if you move, or if there’s a disaster declared by FEMA. Additionally, a SEP is available three months after you begin Medicaid coverage. And a SEP is available for Full Benefit Dual Eligible (FBDE) individuals to align Medicaid and Medicare coverage so they’re provided by the same insurance company. To check your eligibility for a SEP, call a licensed Aetna agent at 1-833-228-1297 (TTY: 711) 7 days a week, 8 AM to 8 PM.
If you qualify for both Medicare and Medicaid, you may be eligible for an Aetna® Dual Eligible Special Needs Plan (D-SNP).
If you're 65 or older and have diabetes or an eligible heart disease, you may qualify for an Aetna® Chronic Condition Special Needs Plan (C-SNP). C-SNPs are currently available in select counties in IL and PA.
You may be eligible for an Institutional Special Needs Plan (I-SNP) if you’ve lived (or plan to live) in a participating facility for 90+ days or you have Medicare Part A (hospital insurance) and Part B (medical insurance).
Aetna Medicare is an HMO, PPO plan with a Medicare contract. Our DSNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.
See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.
Participating health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.
This material is for informational purposes only and is not medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Contact a health care professional with any questions or concerns about specific health care needs.
Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes.
Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to our website.
For members in California, New Jersey and New York FIDE plans: The benefits mentioned are part of special supplemental program for the chronically ill. Eligibility is determined by whether you have a chronic condition associated with this benefit. Standards may vary for each benefit. Conditions include Hypertension, Hyperlipidemia, Diabetes, Cardiovascular Disorders, Cancer. Other eligible conditions may apply. Contact us to confirm your eligibility for these benefits. If you have questions, call us at 1-833-228-1297 (TTY: 711) 7 days a week, 8 AM to 8 PM.
Eligibility for the Model Benefit or Reward and Incentive (RI) Programs under the Value-Based Insurance Design (VBID) Model is not assured and will be determined by Aetna after enrollment, based on relevant criteria (e.g., clinical diagnoses, eligibility criteria, participation in a disease state management program).
For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 14 days. You can call the number on your member ID card if you do not receive your mail-order drugs within this timeframe. Members may have the option to sign-up for automated mail-order delivery.
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