Get step-by-step guidance on how to qualify for both Medicare and Medicaid, and enroll in a low- to no-cost D-SNP almost any time of year
Comparing health plans. Choosing between benefit options. Confirming your eligibility. Navigating all the paperwork. Enrolling in a Dual Eligible Special Needs Plan (D-SNP) — or any health plan — can be a long and confusing process. “It does require a bit of research, paperwork and patience,” says Andy Friedell, chief operating officer of The Helper Bees, an aging-in-place platform in Austin, Texas.
Fortunately, there are some tried-and-true ways to make the whole process easier. Here’s a handy guide to help walk you through D-SNP enrollment. We want to help make it as simple as possible to get the benefits and services you need.
Step 1. Make sure you qualify
To become a D-SNP member, you need to be eligible for both Medicare and Medicaid, says Friedell. That’s where the “Dual” in D-SNP comes from.
How do you know if you qualify for both Medicare and Medicaid?
In general, you’re eligible for Medicare if you’re over age 65. You may be eligible earlier if you have a disability or certain conditions like end-stage renal disease.
If you’re already on both Medicare and Medicaid, then you automatically qualify for a D-SNP. All you need to do is provide proof of both your Medicare and Medicaid cards, says Michelle Katz, LPN, MSN, a health care advocate in the Washington, D.C. area.
Not on Medicaid and don’t know if you qualify for it? The rules for eligibility vary by state. One of the easiest ways to find out if you qualify is to talk to a licensed agent. You can speak with a licensed Aetna® agent for free by calling 1-833-771-3597 (TTY: 711). Agents are available:
- 8 AM to 8 PM, 7 days a week, October 1 to March 31
- 8 AM to 8 PM, Monday-Friday, April 1 to September 30
An Aetna agent can help you through the entire enrollment process for free.
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Step 2. Research the available D-SNP options in your area
There are a lot of different D-SNPs out there. You’ll want to compare them based on cost, coverage and benefits, says Friedell. This can get confusing, so it’s another good time to get help from a licensed agent.
Another option: Check out the website of the health plan you’re interested in. For example, Aetna has a free online tool that makes it easy to search for and compare plans in your service area that may fit your needs. All you need is your ZIP code to get started.
Keep in mind that some D-SNPs are only available for people with full Medicaid benefits. For example, if you only get partial Medicaid because you’re enrolled in a Medicare Savings Program (MSP), you’ll need to find a D-SNP that serves people with an MSP, as well as people with Medicaid.*
Other questions to ask before you enroll in a D-SNP:*
- Are my current doctors in my plan’s network?
- Can I easily get to the plan’s doctors, hospitals and other facilities?
- Does the plan provide any coverage for out-of-network providers?
- Do I need a referral to see a specialist?
- Are my drugs on the plan’s formulary?
A licensed agent can help you answer these and other important questions.
Step 3. Make sure it’s the right time to enroll
Once you’ve picked your D-SNP, you’ll want to call the insurance company to start the enrollment process. The good news: You can do this at several different times throughout the year.*
Initial Enrollment Period. This is when you first become eligible for Medicare. It starts three months before your 65th birthday and continues for 7 months.
Annual Enrollment Period (AEP). The Annual Enrollment Period 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.
Special Enrollment Periods (SEPs). These are periods where you’re allowed to change health plans due to a qualifying life event, says Katz. Examples include if you move out of your current plan’s service area or move into a nursing home.
If you already have Medicaid benefits, or if you become newly eligible for them, you can enroll in a D-SNP during any SEP. There are three SEPs:
- January 1 to March 31
- April 1 to June 30
- July 1 to Sept 30
Step 4. Complete the enrollment process
Ready to enroll? It’s time to contact your chosen plan’s insurance company, says Friedell. Once you do that, they can send you an enrollment form. They may ask to see a copy of your Medicaid card too, to verify that you’re eligible. If you’re enrolling in an Aetna D-SNP, our licensed agents can help you complete the entire process for free.
Enrolling in a health plan just got a lot easier
A licensed Aetna agent can help answer your questions and guide you through the enrollment process from start to finish — for free. Schedule a call with a licensed Aetna representative today — it can’t hurt to learn more.
Step 5. Review your coverage every year
It’s a good idea to review your D-SNP every year during the Annual Enrollment Period, says Katz. This way, you can make sure that all your doctors are still in the plan’s network, and that all your drugs are still covered. If you’re not happy with your plan, you can then switch. Just remember that it won’t go into effect until January 1 of the next year.
If you are eligible for both Medicare and Medicaid, you may be eligible for an Aetna® Dual Eligible Special Needs Plan (D-SNP).
Aetna® is a recipient of the Newsweek America’s Best Customer Service Award for 2023.*
* FOR FULL VERSUS PARTIAL MEDICAID BENEFITS: Medicare Interactive. “Enrolling in a SNP.” Accessed July 23, 2023. back
* FOR QUESTIONS TO ASK BEFORE YOU ENROLL: Medicare Interactive. “Questions to ask before enrolling in a D-SNP.” Accessed July 23, 2023. back
* FOR ENROLLMENT TIMING: Medicare.org. “When can I enroll in a DSNP?” Accessed July 23, 2023. back
* FOR ENROLLMENT TIMING: National Council on Aging. “What is a Dual Eligible Special Needs Plan?” November 30, 2022. Accessed July 23, 2023. back
*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.
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