What is a D-SNP and who can join one?
CMS says D-SNPs enroll people who are entitled to both Medicare and medical assistance from a state Medicaid plan. You need Medicare Parts A and B and must live in the plan's service area.
| Special needs plan | Who it serves |
|---|---|
| D-SNP (dual eligible) | People who have both Medicare and Medicaid, in part or in full. |
| C-SNP (chronic condition) | People with certain severe or disabling chronic conditions. A plan can limit membership to one condition or a group of related conditions. |
| I-SNP (institutional) | People who need an institutional level of care, for example people who live in a facility. |
All three are Medicare Advantage plans, come as an HMO or a PPO, include Part D drug coverage and give care coordination. You can stay in a special needs plan only while you keep meeting the condition it serves.
Premiums vary by plan. If you have Medicare and Medicaid, most of the costs will be covered for you. Some plans require network doctors and some cover out of network care at a higher cost, so ask whether you can keep your primary care doctor. CMS also requires each D-SNP to say whether it has zero dollar Medicare cost sharing, so ask which kind you are looking at.
Which Medicaid groups count as dual eligible?
CMS splits dually eligible people into full benefit and partial benefit groups. Your group decides which special enrollment periods you can use, and the categories can differ by state.
| Group | Medicaid categories CMS lists |
|---|---|
| Full benefit | Full Medicaid benefits alone, Qualified Medicare Beneficiary Plus (QMB Plus) and Specified Low Income Medicare Beneficiary Plus (SLMB Plus) |
| Partial benefit | QMB Only, SLMB Only, Qualifying Individual (QI) and Qualified Disabled and Working Individual (QDWI) |
In fiscal year 2025, nearly 12.5 million people had both Medicare and Medicaid, according to CMS. Of them, 72 percent had full Medicaid benefits and 28 percent had partial benefits. CMS also says 63 percent of full benefit dually eligible people had three or more chronic conditions.
What are the 2026 Medicare Savings Program limits?
A Medicare Savings Program is one way to become partially dual eligible. Your state pays some Medicare costs, and federal limits apply for 2026. States can set higher limits.
| Program | What it helps pay | Monthly income limit | Resource limit |
|---|---|---|---|
| QMB | Part A premium if you pay one, Part B premium, and Medicare deductibles, coinsurance and copayments | $1,350 for one person, $1,824 for a married couple | $9,950 for one person, $14,910 for a married couple |
| SLMB | Part B premium only | $1,616 for one person, $2,184 for a married couple | $9,950 for one person, $14,910 for a married couple |
| QI | Part B premium | $1,816 for one person, $2,455 for a married couple | $9,950 for one person, $14,910 for a married couple |
A fourth program, QDWI, helps pay Part A premiums only. Limits are slightly higher in Alaska and Hawaii, and some states do not count certain income or resources, so you may qualify with more than the federal limits. Apply through your state even if you do not think you qualify.
QI is different: you must apply every year, and states approve applications first come, first served, with priority for people who had QI the year before.
What is an integrated D-SNP?
An integrated D-SNP works with a Medicaid managed care plan from the same company, so your Medicare and Medicaid coverage are coordinated. Not every D-SNP is integrated, so ask the plan how it works.
- 2015669,383
- 2019900,000
- 20211,500,000
- 20232,000,000
- 20252,190,298
Source: CMS Medicare Medicaid Coordination Office, FY 2025 Report to Congress (July 2026)
CMS says about 25 percent of full benefit dually eligible people were in aligned care in 2025. Texas shows how one version works: its Medicaid claims administrator says members are in two plans, an integrated D-SNP for Medicare and a STAR+PLUS plan for Medicaid from the same parent company, with one ID card for both.
Medicare Medicaid Plans, a demonstration in eight states, ended in 2025. CMS says it moved them to integrated D-SNPs on January 1, 2026, and that over 178,000 people had transitioned by December 31, 2025.
When can I join or change a D-SNP?
People with Medicaid or Extra Help can make some changes once a calendar month, and the change takes effect on the first day of the next month. The monthly periods limit which plans you can pick, so match the period to your goal.
| If you | You can |
|---|---|
| Have Medicaid or get Extra Help | Switch to a different Medicare drug plan, or leave Medicare Advantage for Original Medicare with a stand alone drug plan. CMS says this period does not allow enrollment into Medicare Advantage plans that are not D-SNPs. |
| Have full Medicaid benefits | Join or switch to an integrated D-SNP once a calendar month, if one is offered where you live. |
| Are in a Medicare Advantage plan on January 1, 2027 | Make one change from January 1 to March 31, 2027. |
| Want to compare plans for 2027 | Use Medicare's annual enrollment period, October 15 to December 7, 2026. A plan picked by December 7 starts January 1. |
Medicare.gov also lists a special enrollment period if you are no longer eligible for Medicaid. You can call 1-800-MEDICARE for a list of integrated D-SNPs.
What should I check before choosing a D-SNP for 2027?
A D-SNP is a Medicare Advantage plan, so the usual checks apply, plus a few that depend on your Medicaid plan.
- Ask whether the plan is integrated and whether it is paired with your Medicaid plan.
- Look up your doctors, specialists and hospital in the plan's 2027 directory, and your drugs in its 2027 drug list.
- Ask whether the plan has zero dollar Medicare cost sharing.
- Ask what happens to your plan if your Medicaid plan changes. CMS says D-SNPs must contract with states, and states are not required to contract with D-SNPs.
Louisiana shows why this matters. The state ends its Medicaid contract with Healthy Blue on December 31, 2026, and Healthy Blue says it has served Medicare and Medicaid dual eligible members since 2017. Hospital contract disputes can also reach any Medicare Advantage plan from the insurer involved, so check your hospital in the directory of the exact plan.
How can an agent help with a dual eligible plan?
An agent can check which Medicaid group you are in, find D-SNPs where you live, look up your doctors and prescriptions in each plan and explain which dates apply to you. Have your Medicare card, your Medicaid card and your prescriptions ready.
Health Insurance Solutions agents are licensed in 22 states and help by phone and online. Marketplace plans cost the same with or without an agent, so the comparison does not add to your premium.
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