A D-SNP (Dual-Eligible Special Needs Plan) is a Medicare Advantage plan designed for individuals who are:

Why A is correct

A Special Needs Plan is a Medicare Advantage plan that restricts enrollment to a defined population. The D-SNP serves dual-eligible individuals, those entitled to both Medicare and Medicaid, which in California is Medi-Cal, and coordinates the benefits of the two programs. Dual-eligible beneficiaries may receive Medicaid help with Medicare premiums, deductibles, and coinsurance, and the D-SNP is designed around that combined coverage. The 'D' in D-SNP stands for dual eligibility, which is the distinctive, exam-tested feature of this SNP category and is what separates it from the other SNP types.

Why the other options are wrong

• B) Medigap is a supplement to Original Medicare and is not part of the D-SNP design. Owning a Medigap policy has no bearing on eligibility for a dual-eligible SNP.
• C) Most Medicare beneficiaries qualify at age 65, but D-SNP eligibility turns on dual Medicare-Medicaid status, not on being over 65 or free of disability.
• D) A D-SNP provides full medical benefits under Medicare Part C. It is not limited to Part D drug coverage, which is the product of a stand-alone prescription drug plan.

Memory hook

D-SNP = the dual-deck plan for people with both Medicare and Medicaid tickets.

Why A is correct

A dual-eligible Special Needs Plan (D-SNP) is a Medicare Advantage plan designed for people entitled to both Medicare and Medicaid. D-SNPs coordinate the two programs' benefits: Medicare pays first, and Medicaid may cover the beneficiary's cost sharing, including premiums, deductibles, and copayments, depending on the beneficiary's Medicaid share of cost. The plan may offer extra benefits tailored to dual-eligible members. D-SNPs are one of three SNP types, the others being chronic-condition and institutional SNPs, and the coordinated benefits help prevent gaps between Medicare and Medicaid while simplifying provider billing.

Why the other options are wrong

• B) An institutional SNP is designed for facility residents; a D-SNP is defined by dual eligibility, not by where the person lives.
• C) Employer-sponsored coverage is not part of the D-SNP definition, which requires Medicare and Medicaid entitlement.
• D) D-SNP members are dual-eligible, which generally includes people 65 and older or those with qualifying disabilities; being under 65 without a disability is not the criterion.

Memory hook

D-SNP = Double coverage: Medicare plus Medicaid. Two programs, one coordinated plan.

Why C is correct

A Dual-Eligible Special Needs Plan (D-SNP) is a Medicare Advantage plan designed for beneficiaries entitled to both Medicare and Medicaid, who are known as dual eligibles. The plan coordinates Medicare and Medicaid benefits, often paying for items such as deductibles, copayments, and premiums on the member's behalf, and it may include a share-of-cost arrangement for certain services. D-SNPs are one of the three categories of Special Needs Plans under Part C.

Why the other options are wrong

• A) A stand-alone PDP provides only prescription drug coverage and does not coordinate Medicare and Medicaid medical benefits.
• B) Medigap cannot be used by Medicare Advantage enrollees and does not coordinate with Medicaid.
• D) An employer group waiver plan is an employer-based Medicare arrangement, not a dual-eligible coordination plan.

Memory hook

Dual eligible = Medicare plus Medicaid = D-SNP. The plan knits the two programs' benefits together.