How are Dual Special Needs Plans (DSNP) defined?

Dual Special Needs Plans (DSNP) are specifically designed as Medicare Advantage Plans for individuals who are concurrently enrolled in both Medicare and Medicaid. This unique setup allows DSNPs to tailor their benefits and services to meet the health care needs of this population, addressing the complexities that arise from having both types of coverage.

These plans provide integrated care management and can offer additional benefits beyond those available under traditional Medicare. By focusing on individuals who qualify for both programs, DSNPs facilitate access to coordinated health services that consider the social determinants of health, ultimately improving health outcomes and ensuring a more comprehensive approach to care.

In contrast, plans designed solely for Medicare beneficiaries exclude the necessary integration of Medicaid services. Similarly, Medicaid plans with limited services do not specifically cater to those eligible for both Medicare and Medicaid, and health insurance for low-income individuals may encompass a broad array of coverage types that are not exclusively aligned with the dual eligibility criteria defined for DSNPs. Thus, the definition of DSNPs is distinctly tied to their function as Medicare Advantage Plans for those enrolled in both government programs.