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Dual-Eligible Special Needs Plan (D-SNP)

Learn about Dual-Eligible Special Needs Plans (D-SNP) for clients with Medicare and Apple Health (Medicaid) coverage.

Changes in D-SNP options coming January 2021!

View the D-SNP coverage Matrix

What is a D-SNP?

A Dual-Eligible Special Needs Plan (D-SNP) is a special kind of Medicare Advantage plan for dual-eligible individuals. A D-SNP combines Medicare and Apple Health (Medicaid) services under one managed care plan.

Who is a dual-eligible individual?

A dual-eligible individual has both Medicare coverage and Apple Health coverage. This includes physical and behavioral health care coverage.

If you are a dual-eligible client, Medicare is your primary coverage for your physical health care needs. You also have Apple Health as secondary coverage.

Dual-eligible clients also have behavioral health coverage through an Apple Health managed care plan. This is a Behavioral Health Services Only (BHSO) plan. Behavioral health includes mental health and substance use disorder treatment.

D-SNP eligibility and enrollment

Enrolling in a D-SNP does not change what Medicare or Apple Health covers.

The primary benefit of a D-SNP is having one plan for your Medicare and Apple Health coverage. D-SNP coverage makes finding a provider easier, since providers only need to accept one plan.

A D-SNP also improves your care coordination. Being in a D-SNP makes it easier for your providers to make referrals and plan your treatment.

You may choose the same managed care plan for both D-SNP and BHSO coverage. If so, the plan covers both your physical health care and your behavioral health care needs.

Some D-SNP plans offer supplemental benefits in addition to what Medicare and Apple health covers. Please contact the plans for more information.

D-SNP enrollment is open to all dual-eligible clients. If your Apple Health coverage only includes Medicare cost-sharing, you can still enroll in a D-SNP.

The D-SNP Coverage Map shows which counties have D-SNPs coverage.

The D-SNP Coverage Matrix shows which D-SNP is in each county. In some counties, managed care plans have only D-SNPs. In other counties, they have both D-SNPs and BHSOs.

Please consult with your providers to see which plans they accept. You can also contact the plans to see if your providers are in their networks.

You cannot enroll in both a D-SNP and a Health Home program. Enrollment into a D-SNP will disenroll you from your Health Home program. For more information on the Health Home program, see the Health Home page.

If you are eligible for D-SNP coverage, you can enroll during the regular Medicare Advantage enrollment period. You can also enroll during a Special Enrollment Period (SEP).

Each plan may recommend different steps to enroll. Visit their webpages for more information.

How do I contact the plans?

Website Phone number
Amerigroup 1-877-470-4131
Community Health Plan of Washington

Current members: 1-800-942-0247

Prospective members: 1-800-944-1247

Coordinated Care of Washington (WellCare)

Current members: 1-833-444-9089

Prospective members: 1-866-527-0056

Humana 1-800-457-4708
Molina Healthcare of Washington 1-866-403-8293
UnitedHealthcare Community Plan 1-855-273-4568

What if I wish to change my BHSO?

If you enroll in a D-SNP, your BHSO plan will still cover your behavioral health care needs.

You may wish to change your BHSO plan to be the same plan as your D-SNP. You can also choose one plan as your D-SNP and another plan as your BHSO. It is up to you and your providers to choose which plans work best for your healthcare needs.

Visit our Apple Health managed care map and managed care matrix to see which BHSO plans are available in each region.

Contact Washington Apple Health (Medicaid) if you wish to change your Apple Health BHSO plan.

What if I am an American Indian/Alaska Native?

If you are dual-eligible American Indian/Alaska Native, you can:

  • Enroll in an Apple Health BHSO, or
  • Receive Apple Health behavioral health coverage without a managed care plan.

There are advantages and disadvantages to each, depending on your individual circumstances. Tribal health clinic and urban Indian clinic staff are very familiar with these options and can help you make this choice. Learn more about coverage for American Indian/Alaska Natives.

Contact

Apple Health benefits
Contact Washington Apple Health (Medicaid)

Medicare coverage
Contact Medicare

D-SNP managed care plans
Contact the plans