If you have both Medicare and Medicaid, you may qualify for a Dual Special Needs Plan (D-SNP)—a type of Medicare Advantage plan designed specifically for people with dual eligibility. D-SNPs combine your Medicare and Medicaid benefits into one plan, making it easier to manage your healthcare while adding valuable extra benefits.
D-SNPs have grown rapidly in popularity. Enrollment grew from 2.2 million in 2018 to 5.8 million in 2024, as more people discovered the advantages of coordinated care and additional benefits at little to no out-of-pocket cost.
D-SNPs are available in 46 states plus Washington, D.C., including North Carolina. Plan availability varies by county, so you'll need to check which plans are offered in your area.
A D-SNP is a type of Medicare Advantage (Part C) plan. Like all Medicare Advantage plans, D-SNPs are offered by private insurance companies that contract with Medicare to provide your Part A (hospital) and Part B (medical) benefits. Most D-SNPs also include Part D prescription drug coverage.
What makes D-SNPs different is that they're designed exclusively for people who have both Medicare and Medicaid (dual eligibles). The plans coordinate your Medicare and Medicaid benefits so you don't have to manage two separate programs. You keep all your existing Medicaid benefits—the D-SNP adds more coverage on top of what you already have.
D-SNPs must contract with your state's Medicaid agency, which means North Carolina has approved these plans to serve dual-eligible residents. The state reviews the plans to ensure they meet standards for coordinating Medicare and Medicaid benefits.
D-SNPs typically offer more benefits than other Medicare Advantage plans because they're designed for people with greater healthcare needs. Benefits vary by plan, but most D-SNPs include:
Everything in Original Medicare (Parts A and B):
Hospital stays, doctor visits, preventive care, lab tests, and all other Medicare-covered services.
Prescription Drug Coverage (Part D):
Most D-SNPs include prescription drug coverage with $0 copays for many covered medications, including generics and often brand-name drugs. The Part D out-of-pocket maximum is $2,100 in 2026.
Dental Coverage:
Routine dental care includes exams, cleanings, X-rays, fillings, and sometimes more extensive services like crowns or dentures.
Vision Coverage:
Routine eye exams, plus an allowance for eyeglasses frames, lenses, or contact lenses.
Hearing Coverage:
Hearing exams and hearing aids are often offered at $0 or at a reduced cost.
Over-the-Counter (OTC) Allowance:
A monthly or quarterly credit (often loaded onto a benefits card) to buy eligible over-the-counter items like vitamins, pain relievers, first aid supplies, and personal care products.
Healthy Food Allowance:
Many D-SNPs provide a monthly allowance to purchase healthy groceries, especially for members with chronic conditions like diabetes, heart disease, or chronic kidney disease.
Utility Assistance:
Some plans include help paying utility bills (electricity, gas, water) for members with qualifying chronic conditions.
Transportation:
Non-emergency transportation to medical appointments, pharmacies, and other healthcare-related trips.
Fitness Programs:
Gym memberships or fitness programs like SilverSneakers are often at no additional cost.
Care Coordination:
A dedicated care team helps coordinate your healthcare across providers, ensuring your doctors communicate with each other and your Medicare and Medicaid benefits work together.
Note: Benefits vary by plan and location. Some extra benefits (like food and utility allowances) are Special Supplemental Benefits for the Chronically Ill (SSBCI) and are only available to members with qualifying chronic conditions. Always review the plan's Evidence of Coverage for specific benefits.
Most D-SNPs have $0 monthly premiums for members who qualify for Extra Help (Low Income Subsidy). Your out-of-pocket costs depend on your level of Medicaid eligibility:
Full Dual Eligible (Full Medicaid Benefits):
If you receive full Medicaid benefits, nearly all your out-of-pocket costs (premiums, deductibles, copays, coinsurance) are covered by Medicaid. You may pay $0 or close to $0 for most services.
Partial Dual Eligible (Medicare Savings Program):
If you have partial Medicaid benefits through a Medicare Savings Program (QMB, SLMB, QI), Medicaid helps pay some Medicare costs like premiums, but you may have copays for certain services. Not all D-SNPs accept partial dual eligibles—some plans only enroll full dual eligibles.
Because you have Medicaid, you also automatically qualify for Extra Help (Low Income Subsidy), which helps pay Part D prescription drug costs. This means you'll have low or $0 copays for covered medications.
To enroll in a D-SNP, you must meet these requirements:
1. Have Medicare Part A and Part B: You must be enrolled in both parts of Original Medicare.
2. Have Medicaid or a Medicare Savings Program: You must be eligible for Medicaid (full or partial benefits) or enrolled in one of these Medicare Savings Programs:
• Qualified Medicare Beneficiary (QMB)
• Specified Low-Income Medicare Beneficiary (SLMB)
• Qualifying Individual (QI)
• Full Benefit Dual Eligible (receiving full Medicaid benefits)
3. Live in the plan's service area: D-SNPs operate in specific counties or regions. You must live in an area where the plan is offered.
4. Be a U.S. citizen or lawfully present: Standard Medicare eligibility rules apply.
Important: You must renew your Medicaid eligibility annually to stay enrolled in a D-SNP. Your state will send you a renewal notice—be sure to complete it promptly to avoid losing your D-SNP coverage.
Not all D-SNPs are the same. They differ in how well they integrate (combine) your Medicare and Medicaid benefits:
Coordination-Only D-SNPs (CO-SNPs): These plans coordinate your Medicare and Medicaid benefits but don't fully integrate them. You may still need to work with separate programs for different services.
Highly Integrated Dual Eligible SNPs (HIDE SNPs): These plans provide more integrated benefits, covering some Medicaid services directly through the plan.
Fully Integrated Dual Eligible SNPs (FIDE SNPs): These plans offer the highest level of integration, covering both your Medicare and Medicaid benefits in one plan. You work with one plan for all your healthcare needs.
CMS (Centers for Medicare & Medicaid Services) is encouraging more integrated plans to improve care coordination for dual eligibles. Starting in 2025, new enrollment rules make it easier to move from coordination-only plans to more integrated options.
A D-SNP may be a good fit 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 multiple doctors and specialists
• You want extra benefits like dental, vision, hearing, OTC allowances, and transportation
• You want to simplify your healthcare by combining Medicare and Medicaid in one plan
• You want to pay $0 or very little for your healthcare coverage
A D-SNP may not be right if:
• You only have Medicare OR only have Medicaid (you need both)
• You prefer to see doctors who aren't in the plan's network
• No D-SNPs are available in your county
When you can enroll:
Dual eligibles have more enrollment flexibility than other Medicare beneficiaries. You can enroll or switch D-SNPs:
• During Medicare Open Enrollment (October 15 – December 7) for coverage starting January 1
• During the Medicare Advantage Open Enrollment Period (January 1 – March 31)
• Using the Monthly Special Enrollment Period available to dual eligibles, you can switch plans once per month throughout the year
• Using the Integrated Care SEP (starting 2025) to move from a coordination-only D-SNP to a more integrated plan
How to enroll:
• Online through the plan's website or Medicare.gov
• By phone by calling the plan directly or 1-800-MEDICARE
• Through a licensed Medicare agent who can help you compare plans
To enroll in a D-SNP, you need to have both Medicare and Medicaid. If you're not sure whether you have Medicaid or want to apply, contact the North Carolina Medicaid program:
NC Medicaid Contact Center
Phone: 1-888-245-0179
Hours: Monday – Friday, 8:00 a.m. – 5:00 p.m.
TTY: 711 or RelayNC.com
Website: medicaid.ncdhhs.gov
You can also apply for Medicaid online, in person at your local Department of Social Services (DSS), by mail, or through HealthCare.gov.
Note: North Carolina expanded Medicaid in December 2023. If you were previously denied, you may now be eligible. The best way to find out is to apply.
D-SNP availability varies by county and plan. At Health Plans of NC, our Medicare agents can help you:
• Check which D-SNPs are available in your area
• Compare plan benefits, networks, and extra features
• Verify your doctors and pharmacies are in the plan's network
• Understand how your Medicaid and Medicare benefits will work together
• Enroll in the plan that's right for you
Contact us at 1-800-797-0327 for a free consultation. We'll help you understand your D-SNP options and find a plan that meets your healthcare needs.
What is a Dual Special Needs Plan (D-SNP)?
A D-SNP is a type of Medicare Advantage plan designed for people who have both Medicare and Medicaid. It combines your Medicare and Medicaid benefits into one plan, offers extra benefits like dental, vision, and OTC allowances, and provides care coordination to help manage your healthcare.
How much does a D-SNP cost?
Most D-SNPs have $0 monthly premiums for members with Extra Help. If you have full Medicaid benefits, your out-of-pocket costs are covered by Medicaid—you may pay $0 or close to $0 for most services. Partial dual eligibles may have some copays.
Will I lose my Medicaid benefits if I enroll in a D-SNP?
No. Enrolling in a D-SNP does not affect your Medicaid eligibility. You keep all your existing Medicaid benefits—the D-SNP adds more coverage on top of what you already have.
Can I switch D-SNPs during the year?
Yes. Dual eligibles have a Monthly Special Enrollment Period, which means you can switch to a different Medicare Advantage plan or D-SNP once per month throughout the year. You're not limited to the annual enrollment periods that other Medicare beneficiaries are.
What extra benefits do D-SNPs offer?
D-SNPs typically offer dental, vision, hearing, prescription drug coverage (Part D), OTC allowances, transportation, fitness programs, and care coordination. Some plans also offer food allowances and utility assistance for members with chronic conditions. Benefits vary by plan.
How do I qualify for a D-SNP?
You qualify for a D-SNP if you have both Medicare (Parts A and B) and Medicaid (full benefits or a Medicare Savings Program like QMB, SLMB, or QI). You must also live in the plan's service area. If you're not sure about your Medicaid status, call the NC Medicaid Contact Center at 1-888-245-0179.
From Blue Cross NC By Brian Edmonds
