What is a defining factor for consumer enrollment in a D-SNP?

The defining factor for consumer enrollment in a Dual Eligible Special Needs Plan (D-SNP) is Medicaid eligibility. D-SNPs are designed specifically for individuals who are dually eligible for both Medicare and Medicaid. This eligibility is essential because D-SNPs tailor their benefits to meet the unique needs of these individuals, who typically face challenges related to both health care and social services.

Individuals who qualify for Medicaid are generally those with limited incomes and resources, which aligns with the purpose of D-SNPs to provide targeted support that encompasses both health insurance (through Medicare) and financial assistance (through Medicaid). Therefore, without Medicaid eligibility, an individual cannot enroll in a D-SNP, making it the crucial criteria for enrollment.

Other factors mentioned, such as the ability to pay premiums, age, and recent hospital visits, may impact an individual’s health care decisions or other types of coverage, but they do not serve as the primary basis for enrollment in D-SNPs specifically.