Dual Eligible Special Needs Plan (D-SNP)
A Dual Eligible Special Needs Plan, or D-SNP, is a Medicare Advantage plan designed for people who have both Medicare and Medicaid. These individuals are known as “duals” or “dual eligibles”. They all have Medicare part A, part B, or both and can either have full or partial Medicaid. Partial duals do not have full Medicaid, but are eligible to enroll in a D-SNP, if they receive certain types of state assistance with payment of their Medicare premiums or cost sharing. TennCare allows enrollment of “QMB-Only” partial dual eligibles into D-SNPs.
Dual eligible individuals have serious or chronic health conditions that result in higher healthcare costs. It can become difficult for a member to manage both programs alone. A D-SNP coordinates the benefits and services across both programs so members can access medical care, behavioral health services, prescriptions, long-term services and supports, and other important benefits. A D-SNP is the best option for dual eligible individuals to manage their healthcare needs.
A D-SNP helps its members manage their healthcare needs and costs by offering:
- An Interdisciplinary Care Team (ICT): A group of healthcare professionals involved in the member’s care.
- A Coordinator: A main point of contact to assist members in accessing the healthcare services they need.
- An Annual Health Risk Assessment: A review of the member’s health to help create a care plan that meets their needs.
- An Individualized Care Plan: A personalized plan that tracks the member’s health conditions and outlines the care provided and planned, ensuring their healthcare needs are met.
- Additional Supplemental Benefits*: Beyond traditional Medicare. This could include long-term services and supports, durable medical equipment (oxygen equipment, mobility aids, blood sugar monitors, etc.), enhanced dental, vision, and hearing benefits, and monthly food and/or utility allowances.
*Notice: TennCare is not responsible for payment for these benefits, except for appropriate cost sharing amounts. TennCare is not responsible for guaranteeing the availability or quality of these benefits.
Dually eligible individuals have two choices when selecting a D-SNP plan type:
- A Fully Integrated Dual Eligible or “FIDE” SNP plan manages both Medicare and Medicaid benefits under one healthcare provider. A FIDE SNP is the most integrated D-SNP option for dually eligible individuals. Members receive a single member card, one handbook, an integrated provider directory, combined notices, and access to a unified appeals process. This plan is also known as an “aligned plan”
- A “Coordination-Only (CO)” D-SNP is a plan that covers a member’s Medicare benefits and services through the D-SNP, while working with one of the state’s Managed Care Organizations (MCOs) to manage the member’s Medicaid benefits. This plan is also called an “Unaligned plan”
TennCare encourages individuals to enroll in their TennCare MCO’s D-SNP plan to simplify the coordination of both Medicare and Medicaid benefits through one healthcare provider.
- Have Medicare Part A and B or receive assistance from a qualifying Medicare Savings Program
- Receive TennCare Medicaid
- Live in Tennessee
If you have both Medicare and Medicaid, Tennessee offers 6 D-SNP plan options for 2025. You can find each plan profile along with contact information in the D-SNP Comparison Chart.
Juan “Tony” Martinez
More than 12 million people in the U.S. are dually eligible for both Medicare and Medicaid. Tennessee provides Fully Integrated Dual Eligible-Special Needs Plan (or FIDE-SNP) options for individuals who qualify for both programs and are under a single managed care organization (MCO). A FIDE-SNP has special requirements to coordinate the benefits and services of both programs to assist members in managing their healthcare needs and costs in a coordinated and timely manner. The story below reflects the array of positive benefits a FIDE-SNP can have on a person’s life–particularly when the benefits are aligned through one Managed Care Organization.
Juan "Tony" Martinez is enrolled in a FIDE-SNP and the CHOICES program. He has a history of stroke, diabetes, and chronic obstructive pulmonary disease (COPD). He lives alone and receives personal care services and the personal emergency response system (PERS) which includes a call button that he can use to get help in an emergency through CHOICES. Tony’s FIDE-SNP CHOICES Care Coordinator is part of the BlueCare Interdisciplinary Care Team and they have built a strong relationship. She helped him navigate crucial tasks, such as renewing TennCare and managing provider changes in his rural area, ensuring that his care remains safe and effective. This is possible through a combination of both his Medicaid and Medicare benefits.
Tony experienced mobility challenges due to his stroke, including difficulty walking, transferring, and the limited use of his right hand and foot drop. He also has decreased range of motion in his left shoulder. To increase his mobility, he needed a power wheelchair.
In order to obtain the power wheelchair, Tony required a referral to a Durable Medical Equipment (DME) company. His FIDE-SNP CHOICES Care Coordinator partnered with a Health Navigator to assist him in securing this referral through Medicare. Throughout the process, the FIDE-SNP Interdisciplinary Care Team kept Tony informed about the progress of his order. After the wheelchair was delivered, they followed up to ensure it met his needs. Tony was thrilled with the newfound freedom the wheelchair provided. This example shows how helpful it is for members to have a single point of contact to navigate both the Medicaid and the Medicare benefits.
Tony continues to enjoy his increased independence, riding his new power wheelchair outside to collect the mail. He is grateful for the teamwork and dedication of the FIDE-SNP Interdisciplinary Care Team at BlueCare. With the support of FIDE-SNP, Tony’s future looks bright as he continues to live independently and thrive in his community due to the coordination of his Medicare and Medicaid benefits.
Bettie Hill
More than 12 million people in the U.S. are dually eligible for both Medicare and Medicaid. Tennessee provides Fully Integrated Dual Eligible-Special Needs Plan (or FIDE-SNP) options for individuals who qualify for both programs and are under a single managed care organization (MCO). A FIDE-SNP has special requirements to coordinate the benefits and services of both programs to assist members in managing their healthcare needs and costs in a coordinated and timely manner. The story below reflects the array of positive benefits a FIDE-SNP can have on a person’s life–particularly when the benefits are aligned through one Managed Care Organization.
Bettie Hill lives independently in her own home despite several health conditions and her history of falls, primarily occurring when she falls out of bed or bends over to pick up dropped items. She receives assistance from her Interdisciplinary Care Team, which includes a FIDE-SNP CHOICES Care Coordinator that coordinates both her Medicaid and Medicare benefits including home health services, CareBridge 24/7 support, and community resources.
In July 2024, Bettie was hospitalized and the hospital care team recommended moving to a nursing facility. However, Bettie expressed a desire to stay in her home and continue living in the community. Her FIDE-SNP CHOICES Care Coordinator worked closely with her primary care provider (PCP) and Interdisciplinary Care Team to arrange the necessary support for Bettie to safely return home, ensuring she had the right services for wound care and overall health.
To prevent falls, Bettie received a bed rail, which has eliminated falls from her bed. She received other assistive devices, including a Rollator walker, cane, shower chair, bedside commode, and a lift chair to help her maintain independence at home–all through a combination of both her Medicaid and Medicare benefits. Bettie uses a grabber to pick up items from the floor and receives education on managing her chronic conditions and guidance on fall safety. Additionally, Bettie receives in home supports 45 hours a week through her CHOICES services as well as nursing support twice a week through Medicare for wound care. This example shows how helpful it is for members to have a single point of contact to navigate both the Medicaid and the Medicare benefits.
Bettie benefits from the FIDE-SNP U-Card, which helps her purchase healthy food options. She finds it satisfying to buy healthy food that she also enjoys eating. Bettie appreciates the support of the FIDE-SNP and CHOICES benefits, which enables her to stay safely at home while managing her health and financial needs. With the support of FIDE-SNP and the coordinated care across both Medicare and Medicaid benefits, Bettie’s future looks bright as she continues to live independently and thrive in her community.
Members enrolled in a D-SNP can quickly access member documents for each plan by viewing the D-SNP Webpage Resource Links.