What is a D-SNP?
A dual eligible special needs plan (D-SNP) is a type of Medicare Advantage plan limited to people who have Medicare and Medicaid. It covers Part A, Part B and Part D services and must coordinate with your state Medicaid benefits. Federal rules (42 CFR 422.2) set three levels of integration:
- Fully integrated (FIDE SNP): one organization covers Medicare and Medicaid, including long-term services and supports. North Carolina has none.
- Highly integrated (HIDE SNP): covers Medicare plus some Medicaid benefits. North Carolina has none.
- Coordination-only: covers Medicare and coordinates with Medicaid, which still pays its share separately. Every North Carolina D-SNP is this type.
How D-SNPs work in North Carolina
CMS's CY2027 Landscape file shows that every D-SNP sold in North Carolina is coordination-only, as in 2026, and none is listed as an applicable integrated plan. D-SNPs are offered in all 100 counties. CMS lists 57 special needs plans of all types in the state for 2027; by county, from 7 in Onslow County to 41 in Forsyth County. Each D-SNP must have a contract with NC Medicaid (42 CFR 422.107).
Your Medicaid side doesn't change when you join one:
- Full NC Medicaid: NC Medicaid says people who get both Medicaid and Medicare are in NC Medicaid Direct (NC Medicaid's fee-for-service program), not a Standard Plan. State law (G.S. 108D-40) excludes full duals from NC Medicaid Managed Care for a period the state sets, and no date to move them has been announced. Some behavioral health and intellectual or developmental disability services come through an LME/MCO or Tailored Plan.
- Medicare Savings Program only (MQB): people whose Medicaid covers only Medicare premiums and cost sharing are permanently excluded from NC Medicaid Managed Care (G.S. 108D-40(a)(1)).
- CAP/DA: the Community Alternatives Program for Disabled Adults (home and community services instead of a nursing home) requires enrollment in NC Medicaid Direct. A D-SNP doesn't provide CAP/DA services. See the CAP/DA waiver.
- PACE: North Carolina's program that combines Medicare and Medicaid care, for people 55 and older who need nursing-home-level care and live in a PACE area. NC Medicaid lists 11 PACE organizations.
Which options fit your Medicaid
| Your Medicaid | D-SNP? | Other Medicare choices |
|---|---|---|
| Full NC Medicaid (NC Medicaid Direct) | Yes, a coordination-only D-SNP whose eligibility rules include you | Original Medicare with a Part D plan, a regular Medicare Advantage plan, or PACE if you qualify |
| MQB-Q (QMB) only | Some D-SNPs accept it; check the plan | Original Medicare with a Part D plan (and Medigap if you want it), or a regular Medicare Advantage plan |
| MQB-B or MQB-E (SLMB or QI) only | Some D-SNPs accept it; check the plan | Same as above |
| In PACE | No: PACE provides your Medicare and Medicaid care | You would leave PACE to choose another option |
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.
Side by side: D-SNP vs. Original Medicare and NC Medicaid.
When you can join or switch
- Open Enrollment, October 15 to December 7. Anyone with Medicare can change plans for January 1. Open Enrollment for 2027 is under way now.
- Monthly Part D period. People with Medicaid or Extra Help can switch to a standalone Part D plan once per month, which also returns them to Original Medicare if they were in a Medicare Advantage plan (42 CFR 423.38(c)(4)). The federal monthly period for joining an integrated D-SNP (423.38(c)(35)) has no North Carolina plan to use it with, because none is integrated.
- When your Medicaid changes. If you gain, lose or change Medicaid or Extra Help, you get a special enrollment period.
- If you lose Medicaid. If your D-SNP expects you to regain Medicaid within 6 months, for example after a late renewal, it must keep you for at least 30 days and up to 6 months (42 CFR 422.52(d)) before ending your coverage.
Changes generally start the first day of the next month. Call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) for Medicare choices, or the NC Medicaid Contact Center (1-888-245-0179) for Medicaid questions. To review plans from the companies they work with, you can request a call from a licensed insurance agent.
Before you join a D-SNP
- Check that your doctors, hospitals and pharmacies are in the plan's network, and that they also accept NC Medicaid.
- Check your drugs on the plan's formulary.
- Keep your NC Medicaid renewal up to date with your county Department of Social Services: losing Medicaid can end your D-SNP eligibility.
- If you have MQB-Q (QMB), providers may not bill you for Medicare cost sharing, whichever Medicare option you pick. See Can a doctor bill me if I have QMB in North Carolina?
- If your D-SNP is ending for 2027, you'll get a non-renewal notice and a special enrollment period. See plans ending in 2027.
See also NC Medicaid and Medicare and Medicare Savings Programs in North Carolina.
Sources
- Medicare.gov — Special Needs Plans (SNP)
- CMS — Medicare Advantage Landscape files, contract years 2026 and 2027 (D-SNP integration status, counties)
- NC Medicaid — Medicaid Health Plans and Programs (NC Medicaid Direct, Tailored Plans)
- N.C.G.S. 108D-40 — Populations covered by Medicaid managed care
- NC Medicaid — Community Alternatives Program for Disabled Adults (CAP/DA)
- NC Medicaid — Program of All-Inclusive Care for the Elderly (PACE)
- NC Medicaid — Contacts
- eCFR — 42 CFR 423.38, enrollment periods
- eCFR — 42 CFR 422.52, special needs plan eligibility (deemed continued eligibility)
- eCFR — 42 CFR 422.2, definitions (FIDE SNP, HIDE SNP)
- eCFR — 42 CFR 422.107, D-SNP contracts with state Medicaid agencies
- CMS — Qualified Medicare Beneficiary program
Frequently asked questions
Does a D-SNP replace my NC Medicaid?
No. In North Carolina a D-SNP covers your Medicare benefits only. NC Medicaid keeps covering your Medicaid benefits, such as Medicare cost sharing it pays, long-term care and CAP/DA waiver services, usually through NC Medicaid Direct.
What is the dual special enrollment period?
If you have Medicaid or Extra Help, you can switch to a standalone Part D plan once per month (42 CFR 423.38(c)(4)). That also returns you to Original Medicare if you were in a Medicare Advantage plan, including a D-SNP. The change starts the first of the next month.
Can I join a D-SNP in North Carolina if I have only MQB?
Possibly. Each D-SNP's eligibility rules, set with NC Medicaid, say which Medicaid groups it accepts, so some accept people with only a Medicare Savings Program (MQB-Q, MQB-B or MQB-E) and others don't. Check the plan's eligibility rules before you apply.
Why doesn't North Carolina have an integrated D-SNP?
North Carolina hasn't moved people with Medicare and full Medicaid into NC Medicaid Managed Care, and no NCDHHS date for that has been announced. Without a Medicaid plan to align with, no fully or highly integrated D-SNPs are offered. PACE, for people 55 and older who need nursing-home-level care, is the main program that combines both.
Medicare in your North Carolina county
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