A Dual Eligible Special Needs Plan (D-SNP) is designed for beneficiaries who:

Why A is correct

A Dual Eligible Special Needs Plan (D-SNP) is a Medicare Advantage SNP that serves individuals entitled to both Medicare and Medicaid. These plans coordinate the benefits of both programs, and the eligibility group includes dual eligibles who must pay a Medicaid share of cost. The examination objectives specifically identify the Medicare-Medicaid dual eligible population and the share-of-cost component under AH-III.D.1f. Coordinating the two programs reduces fragmentation for a population with complex health needs.

Why the other options are wrong

• B) A D-SNP requires eligibility for both Medicare and Medicaid; Part D enrollment alone does not qualify a person.
• C) ESRD beneficiaries may be served by a different SNP type; D-SNP requires dual eligibility.
• D) Medigap ownership is unrelated and cannot be combined with Medicare Advantage coverage.

Memory hook

D-SNP = dual eligibles, Medicare plus Medicaid, share of cost included.

Why A is correct

A D-SNP is a Medicare Advantage Special Needs Plan serving dual-eligible beneficiaries, people enrolled in both Medicare and Medicaid (Medi-Cal in California). The SNP coordinates the two programs and may address the beneficiary's Medi-Cal share of cost. SNPs target defined populations: dual-eligibles (D-SNP), institutionalized persons (I-SNP), and those with chronic conditions (C-SNP). The dual-eligible/share-of-cost point is in the Part C objectives.

Why the other options are wrong

• B) A D-SNP requires Medicare and Medicaid eligibility, not employer coverage; employer coverage is separate from these programs.
• C) D-SNPs are for dual-eligible beneficiaries, who qualify through Medicare entitlement (age 65+, SSDI, ESRD/ALS), not for people with no qualifying status.
• D) Medicare does not cover long-term custodial care; D-SNPs coordinate Medicare and Medi-Cal benefits but do not turn Medicare into a custodial-care payer.

Memory hook

D-SNP = the bridge plan for people holding both Medicare and Medi-Cal cards.

Why A is correct

A Dual Eligible Special Needs Plan (D-SNP) is a type of Medicare Advantage SNP that enrolls people eligible for both Medicare and Medicaid. Dual eligibles include those with full Medicaid benefits and those with a Medicaid share of cost, meaning the beneficiary pays a monthly share before Medicaid pays. The D-SNP coordinates Medicare and Medicaid benefits to reduce fragmentation. Special Needs Plans in general tailor benefits to specific populations such as institutionalized individuals or those with chronic conditions.

Why the other options are wrong

• B) A D-SNP requires Medicare eligibility; people under 65 with no Medicare coverage are not the target population.
• C) Institutionalized individuals are served by a different type of SNP; the defining feature of a D-SNP is dual Medicare and Medicaid eligibility.
• D) D-SNP enrollees are enrolled in Medicare Part A and Part B as part of their dual eligibility; lack of Part B would disqualify them.

Memory hook

D-SNP = D for dual. One plan joins Medicare and Medicaid, including enrollees with a share of cost.