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D-SNP vs. Original Medicare and NC Medicaid

If you have Medicare and NC Medicaid, your Medicaid usually comes through NC Medicaid Direct whatever you choose for Medicare. The choice is how you get Medicare: a coordination-only D-SNP (every North Carolina D-SNP is this type for 2027), Original Medicare with a standalone Part D plan, a regular Medicare Advantage plan, or PACE if you're 55 or older and need nursing-home-level care.

By the Benefits Life Editorial Team, licensed insurance agents · Reviewed November 13, 2026

The main setups

Coordination-only D-SNP + NC Medicaid: a Medicare Advantage plan for people with Medicare and Medicaid covers your Medicare and drugs and coordinates with NC Medicaid, which pays its share separately.
Original Medicare + Part D + NC Medicaid: Medicare pays first, a standalone Part D plan covers drugs, and NC Medicaid pays what it covers after Medicare.
PACE: one program provides your Medicare and Medicaid care, for people 55 and older who need nursing-home-level care.

A fourth option is a regular Medicare Advantage plan with NC Medicaid alongside it. It works like a D-SNP but isn't required to coordinate with Medicaid, so check that its providers also accept NC Medicaid.

Side by side

Question	Coordination-only D-SNP	Original Medicare + Part D	PACE
Who can use it	Parts A and B, NC Medicaid in a group the plan accepts (full Medicaid or, for some plans, MQB only), living in its service area	Anyone with Parts A and B	Age 55+, nursing-home-level care, living in a PACE area, able to live safely at home with PACE's help
Medicare comes from	The D-SNP	Original Medicare plus a Part D plan you pick	The PACE organization
Medicaid comes from	NC Medicaid, usually NC Medicaid Direct	NC Medicaid, usually NC Medicaid Direct	Through PACE, which NC Medicaid pays
Doctors and hospitals	The plan's network; for Medicaid services, providers who accept NC Medicaid	Any provider that accepts Medicare; for Medicaid services, providers who accept NC Medicaid	PACE's own care team and the providers it arranges
Drug coverage	Included in the plan	A separate Part D plan; Medicaid gives you Extra Help automatically	Included through PACE
Care coordination	Required: the plan must coordinate with NC Medicaid	Separate: Medicare, your Part D plan and NC Medicaid Direct care management	One team for all your care
Long-term services	Not covered by the plan; nursing home Medicaid and CAP/DA come through NC Medicaid Direct	Nursing home Medicaid and CAP/DA come through NC Medicaid Direct	Included through PACE
Medicare cost sharing	NC Medicaid pays what it covers; with MQB-Q, providers can't bill you	NC Medicaid pays what it covers; with MQB-Q, providers can't bill you	Generally none for care your PACE team approves
Appeals	The D-SNP for Medicare services; NC Medicaid for Medicaid	Medicare, your Part D plan and NC Medicaid separately	The PACE organization, then Medicare or NC Medicaid
Changing	Monthly switch to a standalone Part D plan; Open Enrollment	Monthly Part D change; Open Enrollment	You can leave PACE at any time; it ends the first of the next month

Medicare Advantage plans may offer extra benefits such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.

North Carolina points to know

No integrated D-SNPs. CMS's 2027 data show every North Carolina D-SNP is coordination-only, as in 2026. No North Carolina plan covers both Medicare and Medicaid benefits except PACE.
D-SNPs everywhere. D-SNPs are sold in all 100 counties for 2027; CMS counts 57 special needs plans of all types statewide.
NC Medicaid Direct stays. NC Medicaid places people with both Medicare and Medicaid in NC Medicaid Direct, not a Standard Plan; no date to change that has been announced (G.S. 108D-40). MQB-only members are permanently excluded from managed care.
CAP/DA requires NC Medicaid Direct. If you want home and community services instead of a nursing home, see the CAP/DA waiver; the statewide waitlist that began in February 2024 may affect timing.

How to choose

Confirm your Medicaid category. Full NC Medicaid, MQB-Q, MQB-B or MQB-E? Your county Department of Social Services or the NC Medicaid Contact Center (1-888-245-0179) can tell you.
List your doctors, hospitals and drugs. Check each against the D-SNP's network and formulary, or the Part D plan's formulary, and confirm your providers accept NC Medicaid.
Think about how much coordination you need. People with several conditions, frequent hospital stays or home care needs often value one plan or team working with Medicaid.
Consider PACE if you're 55+ and need nursing-home-level care. Ask NC Medicaid whether a PACE organization serves your area.
Make the change. Medicare choices: 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048). Changes generally start the first of the next month.

To talk through D-SNPs and other Medicare plans from the companies they work with, you can request a call from a licensed insurance agent. For details see D-SNPs in North Carolina, NC Medicaid and Medicare and Medicare Savings Programs in North Carolina.

Sources

Frequently asked questions

Is a D-SNP better than Original Medicare if I have NC Medicaid?

It depends on your doctors, drugs and care needs. A D-SNP puts your Medicare care and drugs in one plan that must coordinate with NC Medicaid, but it uses a network. Original Medicare lets you see any provider that accepts Medicare, with a separate Part D plan. Check that your doctors and drugs are covered before you choose.

Will joining a D-SNP change my NC Medicaid?

No. In North Carolina every D-SNP is coordination-only, so NC Medicaid keeps paying for your Medicaid benefits, usually through NC Medicaid Direct, whichever Medicare option you pick.

Can I leave a D-SNP if it doesn't work for me?

Yes. With Medicaid or Extra Help you can switch to a standalone Part D plan once per month, which returns you to Original Medicare. You can also change during Open Enrollment, October 15 to December 7.

What is PACE and who can join in North Carolina?

PACE (Program of All-Inclusive Care for the Elderly) provides Medicare and Medicaid care through one team, often based at a PACE center. You must be 55 or older, need nursing-home-level care, live in a PACE service area and be able to live safely at home with PACE's help. NC Medicaid lists 11 PACE organizations.

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Licensed insurance agents for North Carolina

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