A simple guide to Dual Eligible
Special Needs Plans
(For people who qualify for both Medicare and Medicaid)
Frequently Asked Questions
What is a Dual Eligible Special Needs Plan (DSNP)?
A Dual Eligible Special Needs Plan, or DSNP, is a type of Medicare Advantage plan for people who qualify for both Medicare and Medicaid. These plans are designed to coordinate benefits, simplify coverage, and provide extra services that support health and daily needs.
Who qualifies for a DSNP plan in Pennsylvania?
You may qualify if you have Medicare Part A and Part B, receive Medicaid from Pennsylvania, and live in a county where Jefferson Health Plans offers a DSNP plan. Eligibility is confirmed by both Medicare and Medicaid.
What benefits do Jefferson Health Plans DSNP members receive?
Benefits include all Medicare Part A and B services plus prescription drug coverage, $0 copays, dental, vision, hearing, transportation, and a Flex Card for essentials. Benefits vary by plan; review the Summary of Benefits for details.
Where are Jefferson Health Plans DSNPs available?
They are available in Bucks, Montgomery, and Philadelphia counties in Pennsylvania. You must live in one of these counties to enroll.
How do I enroll in a DSNP plan?
You can enroll if you qualify for both Medicare and Medicaid. Call Jefferson Health Plans, Medicare (1-800-MEDICARE), or visit Medicare.gov to apply.
What is the difference between Medicare Advantage and a DSNP?
All DSNPs are Medicare Advantage plans, but DSNPs include additional coordination and coverage for Medicaid recipients. You get one plan, one card, and one coordinated care team.
Can I change my DSNP plan during the year?
Yes. You can change once per quarter from January through September and during Annual Enrollment (October 15–December 7), or if you qualify for a Special Enrollment Period.
Does Jefferson Health Plans coordinate care for DSNP members?
Yes. Each member has a care coordination team that assists with appointments, medications, and services to ensure appropriate care and support.
Is there a monthly premium for DSNP members?
Most members pay $0 per month. Medicaid often helps cover Medicare premiums, deductibles, and copayments. Confirm details in your plan’s Summary of Benefits.
Where can I get more information about Jefferson Health Plans DSNPs?
Visit jeffersonhealthplans.com/medicare, call Member Services, or review the Summary of Benefits or Evidence of Coverage documents.