The plan that provides both Medicare and Medicaid coverage is called a Dual Eligible Special Needs Plan, or D-SNP. These are a type of Medicare Advantage plan specifically designed for people who qualify for both programs. Instead of juggling two separate sets of benefits, providers, and paperwork, a D-SNP rolls everything into one plan with one card and one network. Some versions go even further, fully integrating medical care, prescriptions, and long-term support services under a single organization.
How D-SNPs Work
D-SNPs receive a fixed monthly payment per member to cover Medicare benefits, similar to other Medicare Advantage plans. The key difference is that D-SNPs also contract with your state’s Medicaid agency. In the most coordinated versions, the plan receives payments from both Medicare and Medicaid, which gives it a financial reason to manage your total care efficiently rather than letting services fall through the cracks between two programs.
These plans have existed since 2006 and were permanently authorized by Congress in 2018. Every D-SNP must have a contract with the state covering things like which Medicaid benefits the plan handles, how it verifies your eligibility for both programs, cost-sharing protections, and which providers participate. Because states set their own rules, the exact benefits and structure vary depending on where you live.
Levels of Integration
Not all D-SNPs coordinate your care to the same degree. There are three tiers worth understanding:
- Standard D-SNPs cover your Medicare benefits and contract with the state, but Medicaid services may still be handled separately.
- Highly Integrated D-SNPs (HIDE SNPs) go further by also covering long-term services and supports, behavioral health, or both under the same plan.
- Fully Integrated D-SNPs (FIDE SNPs) bundle everything: primary care, acute care, long-term services and supports, and behavioral health. These offer the most seamless experience because one organization manages virtually all of your care.
A separate option called Medicare-Medicaid Plans (MMPs) exists in a handful of states through a federal demonstration project. These operate in California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, and Texas. MMPs work similarly to FIDE SNPs in practice, combining both programs under one plan, but they’re structured through a different federal authority.
Who Qualifies as Dual Eligible
To enroll in a D-SNP, you need to be eligible for both Medicare and some form of Medicaid. The specific category you fall into determines which costs get covered. The main groups, with 2026 federal income limits for individuals, are:
- Qualified Medicare Beneficiary (QMB): Monthly income up to $1,350, resources up to $9,950. Medicaid pays your Part A and Part B premiums, deductibles, coinsurance, and copays.
- Specified Low-Income Medicare Beneficiary (SLMB): Monthly income up to $1,616, resources up to $9,950. Medicaid covers your Part B premium.
- Qualifying Individual (QI): Monthly income up to $1,816, resources up to $9,950. Medicaid covers your Part B premium. You cannot have any other Medicaid coverage to qualify.
- Qualified Disabled and Working Individual (QDWI): Monthly income up to $5,405, resources up to $4,000. For people with disabilities who lost premium-free Part A because they returned to work. Medicaid pays the Part A premium only.
Married couples have higher income thresholds across all categories. Limits are also slightly higher in Alaska and Hawaii, and some states set their own thresholds above the federal minimums.
People with “full-benefit” dual eligibility (those who qualify for comprehensive Medicaid, not just help with premiums) get the most complete coverage. They can access the fully integrated and highly integrated D-SNP options and receive additional protections on cost sharing and prescription drugs.
What You Pay Out of Pocket
Full dual eligibility dramatically reduces your costs. If you’re in the QMB program, Medicare providers cannot bill you for Part A or Part B deductibles, coinsurance, or copays. Your state’s Medicaid program picks up those costs. For Medicaid-covered services, you pay at most a small nominal copay that your state sets.
Prescription drug costs drop significantly too. Full-benefit dual-eligible members automatically receive “Extra Help,” which eliminates your Part D premium and deductible entirely. In 2026, you’ll pay no more than $5.10 per generic drug and $12.65 per brand-name drug. Once your total drug costs reach $2,100 for the year, your copays drop to $0. If you have QMB status specifically, your prescription copays are capped at $4.90 per drug from the start.
Benefits Beyond Standard Medicare
D-SNPs consistently offer more supplemental benefits than typical Medicare Advantage plans. Nearly all D-SNPs include dental care (95% of plans), eye exams or glasses (96%), fitness benefits (94%), and hearing exams or aids (92%). But the real difference shows up in benefits that matter most to people managing complex health needs.
Transportation to medical appointments is available through 88% of D-SNPs, compared to just 36% of standard Medicare Advantage plans. Meal delivery benefits appear in 86% of D-SNPs versus 72% of other plans. Nearly a quarter of D-SNPs offer in-home support services, more than double the rate of standard Medicare Advantage options. Over-the-counter health product allowances, bathroom safety devices, and similar practical benefits are also more common. These extras may overlap with or expand on what your state Medicaid program already provides.
HMO vs. PPO Plan Structures
Like other Medicare Advantage plans, D-SNPs come in HMO and PPO versions. HMO-based D-SNPs limit coverage to doctors and hospitals within the plan’s network, except in emergencies. You’ll typically need a referral from your primary care doctor to see a specialist. PPO-based D-SNPs let you see providers outside the network without a referral, though you’ll generally pay more for out-of-network care.
For dual-eligible members, the HMO structure is more common. Because your out-of-pocket costs are already minimal, the main practical concern is whether the providers you currently see are in the plan’s network. Check this before enrolling, especially if you have specialists managing ongoing conditions.
When and How to Enroll
Dual-eligible individuals have far more flexibility to switch plans than most Medicare beneficiaries. Starting in 2025, new enrollment rules replaced the old quarterly switching periods with monthly options. Full-benefit dual-eligible members can make one plan change per month into a FIDE SNP, HIDE SNP, or other integrated plan through the integrated care special enrollment period.
All dual-eligible and Extra Help-eligible individuals can also use the dual/LIS special enrollment period to switch once per month into Original Medicare with a standalone prescription drug plan, or to switch between standalone drug plans. These monthly windows mean you’re never locked into a plan that isn’t working for you.
One restriction: these special enrollment periods don’t allow you to enroll in a non-D-SNP Medicare Advantage plan. You can still join any Medicare Advantage plan during the standard enrollment windows that apply to all Medicare beneficiaries, such as the initial enrollment period or the annual open enrollment period from October 15 through December 7.
To get started, contact your State Health Insurance Assistance Program (SHIP) for free counseling, or search for D-SNPs in your area through Medicare’s plan finder at Medicare.gov. Your local Medicaid office can help determine which dual-eligibility category you fall into and connect you with available plans.