If you have both Medicare and Medicaid, a Dual Special Needs Plan (D-SNP) can simplify your healthcare while providing valuable extra benefits at little to no cost. Nearly 6 million Americans are enrolled in D-SNPs, and North Carolina residents have multiple plan options. Here's everything you need to know about eligibility, benefits, and enrollment.
Dual Special Needs Plans (D-SNPs) are specialized Medicare Advantage plans designed for people who are enrolled in both Medicare and Medicaid. These plans combine your Medicare and Medicaid benefits into one coordinated plan, often with $0 premiums and additional benefits you won't get with Original Medicare alone.
If you're a North Carolina resident who qualifies for both programs, our team of local Medicare agents can help you understand your options and find the right D-SNP for your needs.
As of 2024, approximately 13.7 million Americans are enrolled in both Medicare and Medicaid—making them "dual eligible." This represents roughly 20% of all Medicare beneficiaries. D-SNP enrollment has grown dramatically in recent years, with nearly 6 million dual eligibles now enrolled in these specialized plans, more than double the 2.2 million enrolled in 2018.
D-SNPs now account for 21% of all Medicare Advantage enrollment, reflecting their growing popularity among dual-eligible beneficiaries seeking coordinated care and additional benefits.
To qualify for a D-SNP, you must have coverage under both Medicare and Medicaid. This typically means you:
Are 65 or older, OR have specific disabilities or health conditions that qualify you for Medicare under age 65
Have limited income and resources that qualify you for Medicaid
Are enrolled in Medicare Part A and Part B
Live in the plan's service area
Are you a U.S. citizen or lawfully present in the U.S?
Full vs. Partial Dual Eligibility
There are two types of dual eligibility, and it's important to understand the difference because it affects which D-SNPs you can join:
Full Dual Eligibility: You receive both Medicare and full Medicaid benefits. Medicare covers most of your healthcare services, while Medicaid helps pay for out-of-pocket costs like copays, coinsurance, deductibles, and premiums. Full dual eligibles typically qualify for D-SNPs that provide $0 cost-sharing.
Partial Dual Eligibility: You receive help from a Medicare Savings Program (MSP) that pays certain Medicare costs, but you don't receive full Medicaid medical benefits. Important: Not all D-SNPs accept individuals with partial dual eligibility—some plans are only available to those with full dual eligibility.
In North Carolina, you may qualify for a D-SNP if you're eligible for one of these Medicaid categories:
Full Benefit Dual Eligible (FBDE): Full Medicaid benefits
Qualified Medicare Beneficiary (QMB): Medicaid pays Part A and B premiums, deductibles, and coinsurance
QMB Plus: QMB benefits plus full Medicaid coverage
Specified Low-Income Medicare Beneficiary (SLMB): Medicaid pays Part B premium
SLMB Plus: SLMB benefits plus full Medicaid coverage
Qualifying Individual (QI): Medicaid pays Part B premium (higher income than SLMB)
D-SNPs are a type of Medicare Advantage plan that provides all the benefits of Original Medicare (Parts A and B), plus Medicare Part D prescription drug coverage, all coordinated with your Medicaid benefits. Here's what makes them different:
Coordinated Care: D-SNPs are required to coordinate your Medicare and Medicaid benefits. The best D-SNPs work closely with state Medicaid programs (or are operated by the same company as your Medicaid plan) to provide seamless, integrated care. This means less confusion about which program covers what and fewer gaps in your coverage.
$0 or Low Premiums: Most D-SNPs have $0 monthly premiums for dual-eligible members, and many offer $0 copays for doctor visits, hospital stays, and prescription drugs.
Keep Your Medicaid Benefits: Enrolling in a D-SNP does not affect your Medicaid coverage. You keep all your Medicaid benefits, including long-term care services if applicable.
Care Coordination: D-SNPs typically assign you a care coordinator or care team to help manage your healthcare needs, especially if you have multiple chronic conditions.
Important: You must maintain your Medicaid coverage to stay enrolled in a D-SNP. Medicaid eligibility is reviewed by your state annually, and if you lose Medicaid coverage, you may lose eligibility for your D-SNP.
In addition to covering everything Original Medicare covers, D-SNPs typically include valuable extra benefits such as:
Prescription Drug Coverage (Part D): Built into the plan—no need to buy a separate drug plan
Dental Coverage: Routine checkups, cleanings, and sometimes more extensive dental work
Vision Coverage: Annual eye exams and allowances for eyeglasses or contacts
Hearing Coverage: Hearing exams and hearing aid benefits
Over-the-Counter (OTC) Allowances: Monthly credits for OTC health products like vitamins, pain relievers, and first aid supplies
Healthy Food Allowances: Monthly credits to purchase nutritious groceries (often for members with qualifying chronic conditions)
Utility Assistance: Help paying for utilities (available in some plans for members with chronic conditions)
Transportation: Rides to medical appointments and pharmacies
Fitness Programs: Gym memberships or fitness programs like SilverSneakers
Note: Specific benefits and allowance amounts vary by plan. Some benefits (such as food and utility allowances) may be available only to members with qualifying chronic conditions, such as diabetes, cardiovascular disease, or chronic heart failure. Always review the Summary of Benefits for any plan you're considering.
Not all D-SNPs are created equal. They vary in how much they integrate your Medicare and Medicaid benefits. Understanding these differences can help you choose a plan that best coordinates your care:
Coordination-Only D-SNPs (CO D-SNPs): These plans provide basic coordination between Medicare and Medicaid but don't fully integrate benefits. Your Medicare and Medicaid coverage may still feel like two separate programs.
Highly Integrated D-SNPs (HIDE SNPs): These plans integrate either long-term care services or behavioral health services with Medicare benefits, providing more seamless care for members who need these services.
Fully Integrated D-SNPs (FIDE SNPs): These plans provide the highest level of integration, coordinating both long-term care and behavioral health services with Medicare. They offer the most streamlined experience for dual-eligible members.
Applicable Integrated Plans (AIPs): These D-SNPs offer Medicare and Medicaid benefits from the same company (or affiliated companies), making it easier to manage all your coverage in one place.
Why Integration Matters: Research has shown that when Medicare and Medicaid operate independently, beneficiaries often experience gaps in coverage and fragmented care. Integrated plans are designed to reduce confusion and improve care coordination. Starting in 2025, CMS is requiring D-SNPs to achieve greater integration with state Medicaid programs.
When Can You Enroll?
Unlike regular Medicare Advantage plans, dual-eligible individuals have more opportunities to enroll in or switch D-SNPs throughout the year:
Annual Enrollment Period (AEP): October 15 – December 7 each year. Changes take effect January 1.
Medicare Advantage Open Enrollment Period (MA-OEP): January 1 – March 31 each year. Allows switching Medicare Advantage plans or returning to Original Medicare.
Special Enrollment Periods (SEPs): Dual-eligible individuals have access to special enrollment periods that allow them to make plan changes throughout the year.
Important 2025 Enrollment Changes
Starting January 1, 2025, CMS made significant changes to how dual-eligible individuals can enroll in and switch D-SNPs:
Quarterly SEP Ended: The previous quarterly Special Enrollment Period, which allowed dual eligibles to switch Medicare Advantage plans once per quarter, is no longer available.
New Monthly SEP for Integrated Plans: A new Integrated Care Special Enrollment Period allows full-benefit dual eligible individuals to enroll in certain integrated D-SNPs (FIDE SNPs, HIDE SNPs, and AIPs) once per month, any month of the year. This SEP is designed to encourage enrollment in plans that better coordinate Medicare and Medicaid benefits.
Monthly PDP SEP: Dual eligible and Extra Help-eligible individuals can switch to a standalone Part D prescription drug plan any month of the year.
What This Means for You: If you're unhappy with your current D-SNP or want to switch to a more integrated plan, you may have more flexibility to make changes throughout the year—but the type of plan you can switch to during a SEP depends on its integration level. Talk to a licensed agent to understand your options.
North Carolina residents have multiple D-SNP options available. Some of the insurers offering D-SNPs in NC include:
UnitedHealthcare Dual Complete: Multiple plan options (HMO-POS and PPO) available statewide with benefits like monthly OTC/food/utility allowances, $0 prescription drugs, dental, vision, hearing, and transportation
Healthy Blue + Medicare (Blue Cross NC): Effective January 1, 2026, Blue Cross NC will fully administer Healthy Blue + Medicare (HMO-POS D-SNP) across all 100 NC counties, offering a zero-cost share plan with extra benefits
Other insurers may offer D-SNPs in specific counties—check Medicare.gov or contact a licensed agent for current options in your area.
Plan availability and benefits vary by county, so it's important to verify which plans are offered in your specific location.
A D-SNP may be a good choice if:
You have both Medicare and Medicaid (full or partial benefits)
You have complex medical needs or multiple chronic conditions
You want help coordinating care between Medicare and Medicaid
You'd like extra benefits like dental, vision, hearing, transportation, and OTC allowances
You want prescription drug coverage included in one plan
You prefer $0 or low premiums and minimal out-of-pocket costs
Keep in Mind: D-SNPs are Medicare Advantage plans, which means they typically have provider networks. Make sure your doctors and hospitals are in the plan's network before enrolling. Some D-SNPs are HMO plans (must use network providers), while others are PPO plans (can see out-of-network providers at higher cost) or HMO-POS plans (limited out-of-network options).
The easiest way to understand your D-SNP options is to speak with a licensed Medicare agent who understands both Medicare and North Carolina Medicaid. Our team can:
Verify your dual eligible status and which D-SNPs you qualify for
Compare D-SNP plans available in your area
Check if your doctors and medications are covered
Explain the difference between Medicare and Medicaid
Help you enroll during the correct enrollment period