Dual Eligible Special Needs Plans (D-SNPs), Explained

About 12.8 million Americans had both Medicare and Medicaid in 2024, according to CMS data. They are called dual eligibles, and many of them are older adults who need long-term care. Having two programs can mean two sets of cards, rules and phone calls. Dual eligible special needs plans (D-SNPs) are Medicare Advantage plans designed to bring the two together. This guide explains what D-SNPs are, the different types (including FIDE-SNPs and HIDE-SNPs), how they relate to long-term care Medicaid, and how to decide whether one is right for you or a parent.

Figures change periodically. Double-check current amounts before relying on them.

Medicare and Medicaid: who pays for what

For dual eligibles:

Medicare pays first for hospital care, doctor visits, short skilled nursing stays after a hospital stay, home health, and prescription drugs (through Part D).
Medicaid pays Medicare premiums and cost sharing for many people, and covers services Medicare does not, especially long-term care: nursing home care after Medicare ends, home and community-based waiver services, and personal care.

See Dual eligibility and Medicaid vs. Medicare.

What a D-SNP is

A D-SNP is a Medicare Advantage plan that only enrolls people who have both Medicare and Medicaid. It covers all Medicare Part A and B services and Part D drugs, and it must have a contract with the state Medicaid agency describing how it coordinates with Medicaid. Many D-SNPs offer extra benefits, such as dental, vision, hearing, transportation and allowances for over-the-counter items, and they assign care coordinators.

Enrollment is voluntary on the Medicare side. A dual eligible can choose a D-SNP, another Medicare Advantage plan, or Original Medicare with a stand-alone Part D plan.

The three levels of integration

Federal rules recognize three levels:

Coordination-only D-SNPs. The plan covers Medicare benefits and must share information with the state, for example notifying the state or Medicaid plan when a member goes to the hospital or a nursing home. Medicaid benefits come separately.
Highly integrated D-SNPs (HIDE-SNPs). The plan, or a company related to it, also covers some Medicaid benefits, such as long-term care or behavioral health, under a contract with the state.
Fully integrated D-SNPs (FIDE-SNPs). The plan covers both Medicare and almost all Medicaid benefits, including long-term care, under one company, with one set of member materials and, ideally, one card.

Since 2025 and 2026, federal policy has pushed toward applicable integrated plans, in which a member’s Medicare D-SNP and Medicaid managed care plan are run by the same company, with joint appeals and unified materials. Many states have moved their older dual eligible demonstrations (such as the former Medicare-Medicaid Plans) into this model. Examples include Illinois’s move from its earlier demonstration to fully integrated plans, Ohio’s next-generation MyCare program (see MyCare Ohio), and South Carolina’s move from Healthy Connections Prime to D-SNPs (see South Carolina Healthy Connections Prime).

How D-SNPs relate to long-term care Medicaid

This is where families most often get confused:

Enrolling in a D-SNP does not make someone eligible for long-term care Medicaid. Medicaid eligibility, including the long-term care income and asset rules, the level-of-care test and the five-year look-back, is still decided by the state Medicaid agency.
A coordination-only D-SNP does not pay for nursing home care or waiver services. Those still come through the state’s Medicaid program or its managed long-term care plan.
A FIDE-SNP or aligned plan can pay for long-term care, if the member qualifies, because the same plan covers both programs. In states with managed long-term services and supports, the long-term care plan and the D-SNP may be from the same company. See Managed long-term services and supports.
Nursing home residents can enroll in D-SNPs, and there are also institutional special needs plans (I-SNPs) for people who live in nursing homes long term.

Pros and cons

Possible advantages:

one care coordinator for medical and, in integrated plans, long-term care;
extra benefits such as dental and transportation;
low or no premiums and cost sharing for most duals;
in integrated plans, one appeals process and one set of materials.

Possible drawbacks:

a provider network, so some doctors, hospitals or nursing homes may not be covered;
prior authorization rules;
plan changes from year to year;
for coordination-only plans, the coordination may be limited.

Enrollment rules

Dual eligibles have some special enrollment opportunities. Since January 1, 2025, federal rules give dual eligibles two monthly options in addition to the yearly fall open enrollment period (October 15 to December 7). Once a month, they can leave a Medicare Advantage plan for Original Medicare with a stand-alone drug plan, or switch drug plans. Full-benefit dual eligibles can also enroll once a month in an integrated D-SNP that is aligned with their Medicaid managed care plan. Changes take effect on the first day of the next month. Rules about which plans are available depend on the state and the county.

Choosing a plan

Questions to ask:

Is the plan coordination-only, HIDE or FIDE? Is it aligned with my Medicaid plan?
Are my doctors, hospital, pharmacy and any preferred nursing home or home care agency in the network?
Does the plan cover long-term care, or will that still come from the state?
What extra benefits are included, and what are the limits?
How do I reach the care coordinator?
How do appeals work if a service is denied?

Free, unbiased help is available from the State Health Insurance Assistance Program (SHIP) in every state. Be cautious with sales calls; agents are paid by plans.

D-SNPs and Medicaid planning

D-SNPs do not change the rules for qualifying for long-term care Medicaid. A person who expects to need nursing home or waiver care still needs to meet the income and asset tests, protect a spouse at home, and plan around the look-back. A Certified Medicaid Planner can help with the long-term care side, while the SHIP counselor can help compare Medicare plans.

Common questions

Do I lose Medicaid if I join a D-SNP? No. You must keep Medicaid to stay in a D-SNP. If you lose Medicaid, the plan gives you a grace period to regain it before disenrollment.

Will a D-SNP pay for my mother’s nursing home? Medicare, through the D-SNP, may pay for a short skilled nursing stay after a hospital stay. Long-term nursing home care is paid by Medicaid, either directly by the state or through an integrated plan.

Can I still choose my nursing home? In integrated plans, you generally need a home in the plan’s network.

Are there D-SNPs in every state? Most states have D-SNPs, but the types and level of integration vary by state and county.

Other special needs plans

D-SNPs are one of three types of Medicare special needs plans:

Chronic condition special needs plans (C-SNPs) serve people with specific chronic conditions, such as diabetes, heart failure or dementia, regardless of Medicaid status.
Institutional special needs plans (I-SNPs) serve people who live, or are expected to live, in a nursing home or similar institution for at least 90 days, or who live in the community but need an institutional level of care. They often place nurse practitioners in nursing homes.
D-SNPs serve dual eligibles.

A nursing home resident who has both Medicare and Medicaid may be able to choose among an I-SNP, a D-SNP and Original Medicare. The best choice depends on the nursing home’s relationships with plans and the resident’s doctors.

Medicaid levels within dual eligibility

Not every dual eligible has the same Medicaid coverage. “Full” duals have full Medicaid benefits, including long-term care if they meet the rules. “Partial” duals receive only help with Medicare costs through a Medicare Savings Program. Some D-SNPs enroll only full duals, while others also enroll some partial duals. If a person’s Medicaid is through a Medicare Savings Program only, they do not have long-term care coverage, and would need to apply under the long-term care rules if care is needed.

Example

A widowed father in a nursing home after a hip fracture has Medicare and, after spending down, full Medicaid. Medicare pays for his first weeks of rehabilitation. When he needs long-term care, Medicaid pays the nursing home. If his state has fully integrated plans, one plan may cover both, and his care coordinator handles the switch. If he is in Original Medicare, the nursing home bills Medicare first and then Medicaid, and the family may hear from both.

Where to get help

Each state’s State Health Insurance Assistance Program (SHIP) gives free, unbiased Medicare counseling, including help comparing D-SNPs. The state Medicaid agency or its enrollment broker can explain which Medicaid plans are aligned with which D-SNPs. Your state guide names the agency and the main long-term care programs.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.