Dual Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage plan specifically designed for people who qualify for both Medicare and Medicaid. In New Mexico, where a significant portion of Medicare beneficiaries are also enrolled in Turquoise Care (Medicaid), D-SNPs provide a streamlined way to coordinate benefits from both programs in a single plan.
What Is a D-SNP?
A D-SNP combines your Medicare Part A, Part B, and usually Part D prescription drug coverage into one plan, while also coordinating with your Medicaid (Turquoise Care) benefits. D-SNPs are required to have contracts with the state Medicaid agency, ensuring that your Medicare and Medicaid benefits work together seamlessly.
Benefits of D-SNPs in New Mexico
- Premiums: Vary by plan; depending on your Medicaid level, Medicaid may pay your Part B premium
- Cost sharing: Depending on your Medicaid level, Medicaid may pay your Medicare deductibles and copays
- Coordinated care: One plan manages both your Medicare and Medicaid benefits
- Extra benefits: Some D-SNPs offer dental, vision, hearing and transportation; they vary by plan and may have limits
- Care coordination: Dedicated care coordinators help manage your health needs
- Prescription drug coverage: Part D included; with full Medicaid you also get Extra Help, which lowers drug copays
Who Qualifies for a D-SNP?
To enroll in a D-SNP in New Mexico, you must:
- Be enrolled in Medicare Part A and Part B
- Be enrolled in or eligible for New Mexico Medicaid (Turquoise Care)
- Live in the plan's service area
Enrollment flexibility: People with both Medicare and Medicaid (or Extra Help) have a Special Enrollment Period (SEP) every month: each month you can switch to Original Medicare with a stand-alone Part D drug plan. Full-benefit dual eligibles can also join, each month, certain integrated D-SNPs that are aligned with their Medicaid plan (the integrated care SEP).
D-SNP vs. Regular Medicare Advantage
| Feature | D-SNP | Regular MA Plan |
|---|---|---|
| Eligibility | Must have Medicare + Medicaid | Must have Medicare Parts A & B |
| Medicaid Coordination | Required; integrated benefits | No Medicaid coordination |
| Cost-Sharing | Varies by plan; Medicaid may cover some costs | Varies by plan |
| SEP Access | Monthly SEP to switch to Original Medicare with a Part D plan, or (full-benefit duals) to an aligned integrated D-SNP | Generally limited to AEP/OEP |
How to Enroll in a D-SNP in New Mexico
D-SNP availability varies by county. To see which D-SNPs are available in your area and compare their benefits:
Already on Turquoise Care and Medicare?
If you currently have both Medicare and Turquoise Care but are not enrolled in a D-SNP, a licensed insurance agent can tell you whether a D-SNP is available in your county and how it works with Turquoise Care, at no cost to you.