Dual Eligible Special Needs Plans (D-SNP) in Hawaii
If you have both Medicare and Hawaii's Med-QUEST Medicaid program, a Dual Eligible Special Needs Plan (D-SNP) can dramatically reduce your out-of-pocket costs and add benefits you wouldn't otherwise have access to.
What is a D-SNP?
A D-SNP is a type of Medicare Advantage plan designed exclusively for dual-eligible beneficiaries. To enroll, you must:
- Be enrolled in Medicare Parts A and B
- Be enrolled in Med-QUEST (Hawaii's Medicaid program)
- Live in the plan's service area
D-SNP benefits in Hawaii
Hawaii D-SNPs typically offer:
- $0 monthly premium
- $0 copays for most services (Med-QUEST covers what Medicare doesn't)
- Comprehensive prescription drug coverage with very low or $0 copays through Extra Help
- Care coordination — case managers who help navigate Medicare and Med-QUEST together
- Dental, vision, and hearing benefits
- Transportation — non-emergency medical transportation, often including inter-island travel
- Over-the-counter (OTC) allowances — quarterly or monthly funds for health items
- Healthy food/grocery cards for chronic conditions
- Personal emergency response systems
Who qualifies for D-SNP in Hawaii
You qualify if you have Medicare and any level of Med-QUEST coverage:
- Full Medicaid (Med-QUEST) — full benefits
- QMB (Qualified Medicare Beneficiary) — Medicare premiums and cost-sharing
- SLMB (Specified Low-Income Medicare Beneficiary) — Part B premium only
- QI (Qualifying Individual) — Part B premium only
Each level of dual-eligibility gives different benefits within the D-SNP.
Special Enrollment Period for D-SNPs
Dual-eligible beneficiaries have an integrated care SEP:
- You can change D-SNPs once per quarter (January-March, April-June, July-September)
- You can also change during AEP (October 15 - December 7)
- The integrated care SEP cannot be used in the fourth quarter
Important 2027 alignment rule
Starting January 1, 2027: Dual-eligibles must enroll in their D-SNP and their Med-QUEST plan with the same insurer. If your current D-SNP and Med-QUEST plans are with different carriers, you'll need to align them. The transition is rolling out through 2026 — talk to a Sage PLUS counselor or licensed agent before AEP if this affects you.
D-SNP vs. Original Medicare with Med-QUEST
If you're dual-eligible, you have a choice:
| Feature | Original Medicare + Med-QUEST | D-SNP |
|---|---|---|
| Monthly premium | $0 | $0 |
| Provider choice | Any Medicare provider | D-SNP network only |
| Care coordination | Limited | Comprehensive |
| Extra benefits (dental, vision, OTC) | None from Medicare | Yes |
| Inter-island travel coverage | Med-QUEST NEMT only | D-SNP often expands this |
| Out-of-pocket costs | $0 for most services | $0 for most services |
For most dual-eligibles, D-SNPs provide more benefits with similar (or better) coverage. But if you have specific providers outside the D-SNP network, Original Medicare with Med-QUEST may be preferable.
How to enroll
- Confirm Med-QUEST eligibility — call 1-800-316-8005
- Compare D-SNPs available in your zip code at Medicare.gov Plan Finder
- Talk to Sage PLUS at 1-888-875-9229 for free counseling
- Or work with a licensed agent through MedicareAgents.com
Frequently asked questions
$0 monthly premium for most Hawaii D-SNPs, and $0 copays for most services. Med-QUEST covers what Medicare doesn't. Extra Help (LIS) caps prescriptions at very low amounts.
Yes. Dual-eligibles get a Special Enrollment Period that allows one change per calendar quarter (Jan-Mar, Apr-Jun, Jul-Sep), plus the regular AEP.
You'd lose D-SNP eligibility. Plans typically have a 6-month grace period during which you can either re-establish Med-QUEST or transition to a different plan.
Many Hawaii D-SNPs include non-emergency medical transportation as a supplemental benefit, including inter-island travel for medically necessary care. Coverage varies by plan — ask before enrolling.