Georgia Dual Eligible Special Needs Plan (D-SNP): A Complete Guide

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By Brevy Care Team · Last verified May 13, 2026

A D-SNP is a Medicare Advantage plan authorized under Section 1859(b)(6)(B)(ii) of the Social Security Act for Medicare beneficiaries also enrolled in state Medicaid (dual eligibles). For Georgia dual eligibles in 2026, D-SNPs typically offer $0 premium, $0 medical copays, integrated Part D with automatic Extra Help, and supplemental benefits including dental, vision, hearing, OTC allowance, meals, transportation, and gym membership.

Georgia D-SNP carriers for 2026 include Humana, WellCare, UnitedHealthcare, Aetna, Anthem (Wellpoint), Centene, and Cigna in selective markets. Three integration tiers: Coordination-Only D-SNP (most common in Georgia), Highly Integrated D-SNP (HIDE-SNP), and Fully Integrated D-SNP (FIDE-SNP). Dual eligibles have a Continuous Special Enrollment Period under 42 CFR 422.62(b)(5) allowing up to four plan changes per year. Enrollment through 1-800-MEDICARE; free counseling through GeorgiaCares 1-866-552-4464. :::

::: callout D-SNP Key Takeaways

• A Dual Eligible Special Needs Plan (D-SNP) is a Medicare Advantage plan authorized under Section 1859(b)(6)(B)(ii) of the Social Security Act for dual eligibles (Medicare + state Medicaid).

• For Georgia dual eligibles in 2026: typically $0 premium, $0 medical copays, integrated Part D with automatic Extra Help, and supplemental benefits (dental, vision, hearing, OTC, transportation, gym).

• 2026 Georgia D-SNP carriers include Humana, WellCare, UnitedHealthcare, Aetna, Anthem (Wellpoint), Centene, and Cigna in selective markets. Plan availability varies by county.

• Three integration tiers: Coordination-Only D-SNP (most common in Georgia), HIDE-SNP (substantial Medicaid integration), FIDE-SNP (maximum integration). Coordination-Only dominates the Georgia market.

• Continuous Special Enrollment Period under 42 CFR 422.62(b)(5): dual eligibles can change plans up to four times per year (once per quarter for Q1-Q3 plus once during AEP for Q4).

• State Medicaid Agency Contract (SMAC) requirement under 42 CFR 422.107: all D-SNPs operating in Georgia must have a written contract with DCH covering cost-sharing protections, information sharing, care coordination, and network adequacy.

• Bipartisan Budget Act of 2018 Section 50311 made D-SNPs permanent and enhanced integration requirements. The April 2024 CMS Final Rule (effective PY 2026) further strengthens integration.

• Enrollment: through 1-800-MEDICARE, medicare.gov/plan-compare, or directly with the carrier. Free counseling through GeorgiaCares 1-866-552-4464. :::

A Dual Eligible Special Needs Plan, almost universally called a D-SNP, is a category of Medicare Advantage plan authorized under Section 1859(b)(6)(B)(ii) of the Social Security Act that enrolls only Medicare beneficiaries who are also enrolled in state Medicaid. For Georgia dual eligibles, D-SNPs offer substantial practical advantages over the traditional combination of Original Medicare plus a stand-alone Part D plan plus separately-administered Medicaid: typically $0 plan premium, $0 medical copays for Medicare-covered services (because Medicaid covers Medicare cost-sharing through the QMB and FBDE relationships), integrated Part D with automatic Low-Income Subsidy application, supplemental benefits not available through Original Medicare (dental, vision, hearing aids, over-the-counter allowances, post-discharge meals, non-emergency medical transportation, gym memberships), and care coordination across Medicare and Medicaid services. The Bipartisan Budget Act of 2018 made D-SNPs a permanent component of the Medicare program (no further Congressional reauthorization required) and substantially enhanced integration requirements through Section 50311, which created the Highly Integrated Dual Eligible Special Needs Plan (HIDE-SNP) and Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) categories. The April 2024 CMS Final Rule, effective Plan Year 2026, further strengthens D-SNP integration with new requirements for FIDE-SNPs to cover Medicaid behavioral health, standardized integration tier definitions, network adequacy standards, enhanced care coordination, and marketing rules to reduce beneficiary confusion.

For Plan Year 2026, Georgia dual eligibles have access to D-SNPs from approximately seven to eight carriers including Humana (Humana Gold Plus and Humana Honor variants), WellCare (WellCare Dual Liberty), UnitedHealthcare (UHC Dual Complete), Aetna (Aetna Medicare Dual Eligible), Anthem operating as Wellpoint (Wellpoint Dual Advantage), Centene, Cigna in selective markets, and smaller carriers like Alignment Healthcare and Devoted Health in specific counties. The specific plan options vary by Georgia county: metro Atlanta counties (Fulton, DeKalb, Gwinnett, Cobb, Clayton) typically have the most plan options, while rural counties may have two to three D-SNP options. Each year CMS publishes the official plan list at medicare.gov/plan-compare for the upcoming year, available beginning October 1.

Beyond carrier selection, D-SNPs vary by integration tier. A Coordination-Only D-SNP provides Medicare benefits and coordinates with the state Medicaid agency on cost-sharing and information sharing, but does not cover Medicaid long-term services and supports (LTSS) or behavioral health directly. A HIDE-SNP covers some Medicaid services in addition to Medicare benefits, typically through a Medicaid managed care contract operated by the same parent organization. A FIDE-SNP covers Medicare and comprehensive Medicaid benefits through a unified plan structure, offering the highest level of integration and the simplest beneficiary experience. In Georgia, Coordination-Only D-SNPs are the most common because Georgia Medicaid does not extensively use managed long-term services and supports (MLTSS); HIDE-SNPs and FIDE-SNPs are limited. This guide gives Georgia families the complete picture: the federal framework (Section 1859 of the Social Security Act, 42 CFR Part 422 Subpart F, MIPPA 2008, BBA 2018, the 2024 CMS Final Rule), the three integration tiers, who can enroll and how, the 2026 Georgia D-SNP carrier landscape, supplemental benefits, the Continuous Special Enrollment Period under 42 CFR 422.62(b)(5), the State Medicaid Agency Contract requirement under 42 CFR 422.107, disenrollment options, and worked examples for common Georgia scenarios.

The Federal Framework

D-SNPs sit at the intersection of Medicare Advantage, Medicaid integration, and federal regulatory oversight. Understanding the framework helps Georgia families and their advocates make the most of these plans.

Origin: Medicare Modernization Act of 2003

The Medicare Modernization Act of 2003 (MMA, Public Law 108-173) created Medicare Advantage Special Needs Plans (SNPs) as a new category of MA plan under Section 1859(b)(6) of the Social Security Act. SNPs serve specific Medicare beneficiary populations with focused care coordination. The three SNP categories:

• D-SNP (Dual Eligible): Section 1859(b)(6)(B)(ii) authorizes plans serving dual eligibles
• C-SNP (Chronic Condition): Section 1859(b)(6)(B)(iii) authorizes plans serving beneficiaries with specific chronic conditions
• I-SNP (Institutional): Section 1859(b)(6)(B)(i) authorizes plans serving nursing facility residents and beneficiaries requiring nursing facility level of care

D-SNPs were originally authorized for a limited period, requiring Congressional reauthorization at intervals. Multiple extensions kept the program alive through 2018, when Congress made it permanent.

Section 1859(b)(6)(B)(ii) of the Social Security Act

The statutory authority for D-SNPs requires that the plan enroll only individuals entitled to medical assistance under a state Medicaid plan. The qualifying dual eligible categories:

• Full Benefit Dual Eligible (FBDE): Medicare beneficiary with full Medicaid (QMB Plus or non-QMB FBDE)
• QMB-only: Medicare beneficiary with QMB (no full Medicaid)
• QMB Plus: Medicare beneficiary with QMB and full Medicaid
• SLMB-only: Medicare beneficiary with SLMB
• SLMB Plus: Medicare beneficiary with SLMB and full Medicaid
• QI: Medicare beneficiary with QI (mutually exclusive with full Medicaid)

Each D-SNP specifies in its CMS application which dual eligible categories it will serve. Some plans serve all categories. Others limit enrollment to specific categories: FBDE-only D-SNPs are common, providing the most integrated benefits to the highest-need population.

MIPPA 2008: Section 162 D-SNP Categories

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) Section 162 created three D-SNP integration categories based on the degree of Medicaid integration:

1. Coordination-Only D-SNP: minimum integration. The plan contracts with the state Medicaid agency for information sharing and cost-sharing coordination but does not cover Medicaid LTSS or behavioral health directly. Beneficiaries access Medicaid services separately through Medicaid fee-for-service or Medicaid managed care.

2. Highly Integrated Dual Eligible Special Needs Plan (HIDE-SNP): substantial integration. The plan covers some Medicaid services such as LTSS or behavioral health in addition to Medicare benefits, typically through a Medicaid managed care contract operated by the same parent organization.

3. Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP): maximum integration. The plan covers Medicare and comprehensive Medicaid benefits through a unified plan structure, typically operated by a Medicaid Managed Care Organization that also operates the D-SNP. Beneficiaries have one card, one provider network, and one care coordinator for both Medicare and Medicaid services.

Bipartisan Budget Act of 2018: Section 50311 Permanent Authorization

The Bipartisan Budget Act of 2018 (BBA 2018, Public Law 115-123) Section 50311 made foundational changes:

• Made D-SNPs permanent (no further Congressional reauthorization required)
• Required all D-SNPs to have State Medicaid Agency Contracts (SMACs)
• Enhanced integration requirements
• Required CMS to develop unified appeals and grievance processes for HIDE-SNPs and FIDE-SNPs
• Created the broader Medicare-Medicaid integration framework

The permanent authorization gave carriers and beneficiaries planning certainty. Before BBA 2018, periodic reauthorization battles created uncertainty about whether D-SNPs would continue to operate.

April 2024 CMS Final Rule (Effective Plan Year 2026)

The CMS Final Rule published April 2024 strengthens D-SNP integration with provisions effective for Plan Year 2026:

• New requirements for FIDE-SNPs to cover Medicaid behavioral health services
• Standardized integration tier definitions (clarifying differences between Coordination-Only, HIDE-SNP, and FIDE-SNP)
• Network adequacy standards specific to D-SNPs
• Enhanced care coordination requirements (minimum standards for high-risk member outreach)
• Marketing rule changes to reduce confusion about D-SNP benefits versus standard MA
• Adjustments to the Continuous SEP for dual eligibles (now quarterly instead of monthly)

42 CFR Part 422 Subpart F: D-SNP Regulations

The federal regulations implementing D-SNPs at 42 CFR 422.2 through 42 CFR 422.572 provide operational detail:

• 42 CFR 422.2: D-SNP definitions
• 42 CFR 422.107: State Medicaid Agency Contract (SMAC) requirement
• 42 CFR 422.504(g)(1)(iv): Prohibition on charging dual eligibles for Medicare cost-sharing
• 42 CFR 422.560: D-SNP grievance and appeals process
• 42 CFR 422.62(b)(5): Continuous Special Enrollment Period for dual eligibles

42 CFR 422.107: State Medicaid Agency Contract

The SMAC requirement is foundational to D-SNP operation. Every D-SNP must have a written contract with the state Medicaid agency (DCH in Georgia) covering:

1. The MA organization's responsibilities to enrollees
2. Cost-sharing protections for dual eligibles (no balance billing for QMBs, etc.)
3. Information sharing between the D-SNP and the state Medicaid agency
4. Care coordination requirements
5. Network adequacy
6. Beneficiary protections
7. Reporting and oversight

DCH publishes a SMAC template for D-SNPs operating in Georgia. The 2026 SMAC template includes integration requirements aligned with the CMS Final Rule.

The Three D-SNP Integration Tiers

The integration tier substantially affects how a D-SNP operates and what services beneficiaries access through the plan.

Coordination-Only D-SNP

The simplest D-SNP structure and the most common type in Georgia:

• Plan provides Medicare Part A, Part B, and (typically) Part D benefits
• Plan has an SMAC with DCH covering coordination requirements
• Plan coordinates with Medicaid on cost-sharing (Medicaid pays Medicare cost-sharing through the state buy-in for QMB and FBDE enrollees)
• Plan does NOT cover Medicaid LTSS, behavioral health, or other Medicaid-specific services
• Beneficiary accesses Medicaid services separately through Medicaid fee-for-service Georgia Medicaid or limited Medicaid managed care

For a beneficiary using Original Medicare plus a stand-alone PDP plus Medicaid LTSS, a Coordination-Only D-SNP combines Medicare and Part D into one card and adds supplemental benefits, but the LTSS experience continues separately.

In Georgia, Coordination-Only D-SNPs dominate the market because Georgia Medicaid has not extensively adopted managed long-term services and supports. The Community Care Services Program (CCSP) waiver and SOURCE program operate through fee-for-service Medicaid rather than through MCO contracts.

Highly Integrated Dual Eligible Special Needs Plan (HIDE-SNP)

A more integrated structure:

• Plan covers Medicare Part A, Part B, and Part D benefits
• Plan ALSO covers some Medicaid services through a Medicaid managed care contract operated by the same parent organization
• Common Medicaid services covered by HIDE-SNPs: LTSS (HCBS or NF), behavioral health, certain prescription drugs not covered by Part D, transportation, dental
• Beneficiary uses the same plan for both Medicare and most Medicaid services

In Georgia, HIDE-SNPs are limited because Georgia Medicaid does not extensively use MLTSS. Some carriers offer HIDE-SNPs that cover specific Medicaid benefits such as behavioral health.

Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP)

The maximum integration:

• Plan covers Medicare A, B, D AND comprehensive Medicaid benefits
• Operated by a single integrated organization with both Medicare Advantage and Medicaid managed care contracts
• Beneficiary has one card, one provider network, one care coordinator for both Medicare and Medicaid services
• Substantially reduces beneficiary confusion and provider billing complexity
• Requires state Medicaid agency Memorandum of Understanding (MOU) and active state participation in the integration

FIDE-SNPs are limited in Georgia. National FIDE-SNP states with more developed integration include Minnesota, New York, Massachusetts, Arizona, Hawaii, and Idaho. In Georgia, a small number of FIDE-SNPs operate in metro Atlanta.

For Georgia families, the practical implication: most D-SNP options will be Coordination-Only, with limited HIDE-SNP and FIDE-SNP availability. Future Medicaid managed care expansion in Georgia could increase HIDE-SNP and FIDE-SNP options.

2026 Georgia D-SNP Carriers

For Plan Year 2026, Georgia D-SNP options typically include the following carriers. Specific plan availability varies by county.

Humana

Humana offers multiple D-SNP product lines:

• Humana Gold Plus D-SNP: HMO structure, broad provider network in metro Atlanta and statewide
• Humana Honor D-SNP: tailored for specific veteran and dual eligible populations
• Some Humana D-SNPs operate as HIDE-SNPs in specific markets

Humana customer service: 1-800-457-4708.

WellCare (Centene Subsidiary)

WellCare Dual Liberty is the primary WellCare D-SNP brand in Georgia:

• HMO and PPO variants by county
• Strong rural county coverage
• Competitive supplemental benefits including OTC and transportation

WellCare customer service: 1-866-799-5318.

UnitedHealthcare

UnitedHealthcare Dual Complete is the largest national D-SNP brand:

• HMO structure with broad networks
• Strong metro Atlanta coverage with statewide expansion
• Integrated case management for complex members

UnitedHealthcare customer service: 1-877-542-9236.

Aetna (CVS Health Subsidiary)

Aetna Medicare Dual Eligible:

• HMO structure
• Competitive supplemental benefits (dental and OTC particularly strong)
• Integrated pharmacy through CVS

Aetna customer service: 1-855-463-0933.

Anthem (Wellpoint Subsidiary)

Wellpoint Dual Advantage:

• HMO structure
• Growing Georgia presence
• Behavioral health integration in some plans

Centene (Separate from WellCare)

Centene operates additional D-SNP brands beyond WellCare in selective markets.

Cigna

Cigna HealthCare Dual Eligible in selective markets:

• Limited Georgia footprint
• HMO structure where offered

Alignment Healthcare and Devoted Health

Smaller national carriers offering D-SNPs in selective Georgia counties.

The specific D-SNP options for each Georgia county can be found at medicare.gov/plan-compare. GeorgiaCares (1-866-552-4464) maintains a current list of Georgia D-SNPs and can help beneficiaries compare plans.

Who Can Enroll in a D-SNP in Georgia

D-SNP enrollment requires specific qualifications.

Basic Eligibility Requirements

1. Medicare entitlement: enrolled in Medicare Part A AND Part B
2. Service area residence: resident of the D-SNP's service area (specific Georgia counties)
3. Dual eligible status: one of the qualifying Medicaid categories (FBDE, QMB, SLMB, QI)
4. Plan-specific category: some D-SNPs accept only specific dual categories (e.g., FBDE-only plans)

The Continuous Special Enrollment Period (Quarterly)

Under 42 CFR 422.62(b)(5) as updated by the 2024 CMS Final Rule, dual eligibles have a Continuous Special Enrollment Period allowing:

• Q1 (January 1 - March 31): one plan change effective February 1, March 1, or April 1
• Q2 (April 1 - June 30): one plan change effective May 1, June 1, or July 1
• Q3 (July 1 - September 30): one plan change effective August 1, September 1, or October 1
• Annual Election Period (October 15 - December 7): one plan change effective January 1 of the following year

Total: up to four plan changes per calendar year. This is much more flexible than standard Medicare beneficiaries, who can only change plans during the AEP and the limited MA Open Enrollment Period (January 1 - March 31, one switch).

Note: prior to the 2025 CMS Final Rule, dual eligibles had a true monthly SEP. The rule restricted the SEP to quarterly to reduce churn and marketing-driven switching while preserving meaningful flexibility.

Other Enrollment Windows

Dual eligibles can also enroll or change plans during:

• Initial Enrollment Period (IEP): the 7-month window around the 65th birthday (3 months before, the birthday month, and 3 months after)
• Special Enrollment Period for Loss of Coverage: triggered by loss of other creditable coverage
• 5-Star Special Enrollment Period: enroll in a 5-star plan year-round
• MA Open Enrollment Period (OEP) January 1 - March 31: allows MA-to-MA or MA-to-Original Medicare with PDP switch; one change per year
• Annual Election Period (AEP) October 15 - December 7: enroll, change, or disenroll for January 1 effective date

Disenrollment from D-SNP

A dual eligible can disenroll from a D-SNP through:

• Switching to another D-SNP during a Continuous SEP quarter
• Switching to a standard MA plan during AEP or MA OEP
• Switching to Original Medicare plus a stand-alone PDP during AEP or MA OEP
• Moving to a state outside the D-SNP service area (triggers SEP)
• Losing Medicaid status (typically results in 6-month grace period during which the beneficiary can regain Medicaid before D-SNP disenrollment)

If a beneficiary loses Medicaid status (e.g., MSP terminates at redetermination because income exceeds the threshold), the D-SNP either:

1. Moves the beneficiary to a similar non-D-SNP plan operated by the same carrier (default behavior); or
2. Disenrolls the beneficiary to Original Medicare (if no similar non-D-SNP plan exists)

The 6-month grace period gives the beneficiary time to regain Medicaid eligibility (e.g., through Pickle Amendment or asset spend-down) without losing the D-SNP entirely.

D-SNP Benefit Structure

D-SNP benefits in 2026 are extensive, especially compared to Original Medicare.

Medicare Benefits

All D-SNPs cover Medicare Part A (hospital, skilled nursing facility, hospice, home health) and Part B (medical, preventive, durable medical equipment). The MA structure means:

• Plan has a provider network (HMO requires staying in-network; PPO allows out-of-network at higher cost)
• Plan negotiates rates with providers
• Some plans require referrals to specialists; others do not
• Plan covers Medicare-covered services with the plan's cost-sharing structure (typically $0 for D-SNP dual eligibles because of the QMB/FBDE relationship)

Medicare Cost-Sharing for Dual Eligibles

For QMB and FBDE enrollees in D-SNPs, Medicaid covers Medicare cost-sharing through:

• State buy-in for Part B premium ($202.90/month in 2026)
• State buy-in for Part A premium (if applicable; 2026 amounts vary by qualifying work quarters)
• Medicaid as secondary payer for Medicare deductibles ($1,736 Part A, $283 Part B in 2026) and coinsurance (20% Part B, hospital and SNF coinsurance Part A)

D-SNPs cannot charge dual eligibles for Medicare cost-sharing under 42 CFR 422.504(g)(1)(iv). For QMBs specifically, Section 1902(n) of the Social Security Act prohibits all balance billing.

Part D Integration

Most D-SNPs are Medicare Advantage Prescription Drug (MAPD) plans with integrated Part D. The Extra Help (Low-Income Subsidy) applies automatically to dual eligibles enrolled in D-SNPs:

• $0 Part D premium (D-SNPs typically structure Part D to be a benchmark plan for dual eligibles)
• $0 annual deductible
• $4.90 generic copay / $12.15 brand copay for community beneficiaries
• $0 copays for nursing facility residents and qualifying HCBS waiver participants under Section 1860D-14 NF rule

Supplemental Benefits

D-SNPs typically offer extensive supplemental benefits beyond Original Medicare. Specific benefits vary by carrier, plan, and county, but typical 2026 offerings include:

Dental:

• Preventive care (cleanings, exams)
• Comprehensive care (fillings, extractions, dentures, sometimes implants)
• Annual benefit caps typically $1,000 to $3,000

Vision:

• Annual eye exam
• Eyeglasses allowance ($100 to $300 per year)
• Contact lens benefit

Hearing:

• Annual hearing exam
• Hearing aid allowance ($500 to $3,000 per ear per year, varying by plan)

Over-the-Counter (OTC) Allowance:

• Quarterly OTC card or catalog allowance for non-prescription items (vitamins, pain relievers, first aid, personal care)
• $50 to $500 per quarter (highest for FIDE-SNPs and HIDE-SNPs)

Meal Benefits:

• Post-hospitalization meals (typically 14 to 28 meals delivered after discharge)
• Some plans include monthly meal benefits for chronic condition members

Transportation:

• Non-emergency medical transportation to provider appointments
• Typically 24 to 48 one-way trips per year

Fitness:

• SilverSneakers membership at participating gyms
• Home fitness kit alternative
• Yoga, Tai Chi, or similar wellness programs

Flex Card / Spend Allowance:

• Pre-loaded card for healthcare expenses ($100 to $1,000 per year, varying by plan)
• Can cover dental, vision, hearing, OTC, sometimes utilities or groceries

The 2026 supplemental benefits have generally narrowed compared to 2024 peaks due to CMS rules limiting "premium reduction" benefit packages and refocusing on health-related supplemental benefits.

Care Coordination

D-SNPs are required to provide care coordination services for enrollees, including:

• Health Risk Assessment (HRA) at enrollment and annually
• Individualized Care Plan (ICP) based on the HRA
• Care coordinator assignment for high-risk members
• Coordination with Medicaid LTSS, behavioral health, and other community services
• Transitions of care support (hospital to home, hospital to SNF, SNF to home)

For HIDE-SNPs and FIDE-SNPs, care coordination extends to Medicaid-covered services. For Coordination-Only D-SNPs, coordination focuses on Medicare with referrals to Medicaid services.

How D-SNPs Compare to Other Coverage Options

A Georgia dual eligible has several Medicare coverage options. Comparing them helps families choose the right approach.

D-SNP vs Original Medicare + PDP + Medicaid

D-SNP advantages:

• Integrated care coordination
• $0 medical and prescription copays
• Supplemental benefits (dental, vision, hearing, OTC, transportation)
• Single ID card and customer service line

Original Medicare advantages:

• Any provider that accepts Medicare nationwide
• No plan network restrictions
• No referral requirements
• More flexibility for snowbirds and frequent travelers

For dual eligibles who travel frequently, need specific specialists not in any D-SNP network, or value provider flexibility, Original Medicare may be preferable. For dual eligibles who value coordination and supplemental benefits, D-SNP is typically better.

D-SNP vs Standard Medicare Advantage

D-SNP advantages:

• Specifically designed for dual eligibles
• Full integration with Medicaid cost-sharing
• SMAC ensures cost-sharing protections
• Often better supplemental benefits

Standard MA disadvantages for dual eligibles:

• May not have SMAC with DCH
• May not coordinate well with Medicaid
• May charge for cost-sharing that should be covered by Medicaid (problematic and often violates federal law)
• Generally less integrated experience

Dual eligibles can enroll in standard MA plans, but D-SNPs are almost always a better fit when available.

D-SNP vs FIDE-SNP

Coordination-Only D-SNP: Medicare benefits only, Medicaid accessed separately HIDE-SNP: Medicare plus some Medicaid services through same parent organization FIDE-SNP: Medicare plus comprehensive Medicaid through unified plan structure

In Georgia, FIDE-SNPs are limited, so most dual eligibles will choose between Coordination-Only D-SNPs and any available HIDE-SNPs. The integration tier affects how seamless the experience is, but all three categories provide substantial benefits.

D-SNP vs PACE

Programs of All-Inclusive Care for the Elderly (PACE) is a separate program for very frail elders meeting nursing facility level of care criteria. PACE provides comprehensive Medicare and Medicaid services through a single program with a multidisciplinary team. PACE is available in limited Georgia areas (primarily metro Atlanta through specific PACE organizations). PACE is more intensive than even FIDE-SNPs and serves a narrower population.

Worked Examples

Six common Georgia D-SNP scenarios.

Example 1: Anna 72 Atlanta QMB enrolls in D-SNP

Anna, 72, lives in Atlanta. QMB beneficiary effective March 1, 2026. She has been on Original Medicare with a stand-alone Part D plan for several years. Her annual Medicare cost-sharing is covered by Medicaid through QMB benefits. Her PDP has $0 premium (LIS benchmark plan) and $4.90 generic copays.

In May 2026, Anna receives marketing materials from several D-SNP carriers and is confused about whether to switch. She calls GeorgiaCares for assistance. The counselor explains:

• D-SNPs are designed specifically for dual eligibles like Anna
• $0 premium, $0 deductible
• $0 medical copays because Medicaid covers Medicare cost-sharing through QMB
• Part D integrated with LIS rules ($4.90 generic / $12.15 brand, $0 in NF)
• Supplemental benefits: $1,500 dental annually, $250 vision allowance, $1,500 hearing aid allowance per ear, $100 quarterly OTC, SilverSneakers gym membership, 24 one-way transportation trips per year

The counselor compares Anna's two top D-SNP options (UnitedHealthcare Dual Complete and Humana Gold Plus D-SNP) on:

• Provider network (Anna's primary care physician and cardiologist are in-network for both)
• Formulary coverage of her five medications (both cover all five)
• Supplemental benefit comparison (UnitedHealthcare has higher hearing aid allowance; Humana has higher dental cap)
• Star ratings (both 4 stars in 2026)

Anna decides on UnitedHealthcare Dual Complete based on the hearing aid allowance (she anticipates needing aids). The counselor processes the enrollment during Anna's Continuous SEP (Q2, effective June 1, 2026). Anna's annual D-SNP supplemental benefit value is approximately $3,000+ depending on actual utilization.

Example 2: Roberto 75 Savannah FBDE in FIDE-SNP

Roberto, 75, lives in Savannah. Full Benefit Dual Eligible (FBDE) due to early-stage dementia and ABD Medicaid status. Roberto is enrolled in a Wellpoint FIDE-SNP operating in his county that integrates Medicare and Medicaid into a single plan structure.

Roberto's dementia advances over 2026. By August, he requires 24-hour care that his wife (his primary caregiver) cannot provide alone. The family decides on nursing facility placement at a Savannah long-term care facility.

The FIDE-SNP coordinates the transition:

• Medicare coverage: Wellpoint FIDE-SNP covers acute hospitalization for delirium episode prior to NF admission, skilled nursing facility days 1-100 (up to 100 days, depending on rehabilitation progress)
• Medicaid coverage: same Wellpoint FIDE-SNP covers long-term nursing facility care after Medicare SNF benefit exhaustion (under the integrated structure, Medicaid LTSS is administered through the plan)
• Care coordinator: a single FIDE-SNP care coordinator assigned to Roberto manages the entire transition
• Part D: $0 copay under NF rule
• Family experience: one phone number, one care coordinator, one explanation of benefits

Roberto's wife appreciates the integrated experience. In a non-FIDE-SNP arrangement (Original Medicare + PDP + fee-for-service Medicaid), the family would have to coordinate Medicare benefits, PDP, and Medicaid separately during the transition, with potentially conflicting information and three different appeals processes.

Example 3: Patricia 68 Macon D-SNP supplemental benefits utilization

Patricia, 68, lives in Macon. QMB beneficiary enrolled in Humana Gold Plus D-SNP. Patricia's supplemental benefit utilization in 2026:

• Dental: $1,200 used (root canal and crown at her in-network dentist)
• Vision: $200 used (annual eye exam plus new eyeglasses)
• Hearing aid: $2,800 used (one premium hearing aid; Humana's hearing benefit covered $1,500, Patricia paid $1,300 out of pocket)
• OTC quarterly: $100 quarter × 4 = $400 used (vitamins, OTC pain relievers, first aid supplies)
• Transportation: 12 round trips used (to specialist appointments at Macon facilities)
• Gym: 2 visits per week to SilverSneakers gym ($50/month membership value × 12 = $600)

Patricia's total annual D-SNP supplemental benefit value:

• Dental: $1,200
• Vision: $200
• Hearing: $1,500 (covered portion only)
• OTC: $400
• Transportation: estimated $300 (Medicare equivalent value)
• Gym: $600
• Total: approximately $4,200

Without the D-SNP, Patricia would have paid these out of pocket. The supplemental benefits substantially improve her quality of life and access to preventive care. Combined with $0 medical copays (Medicaid covers Medicare cost-sharing through QMB) and $0 Part D premium (LIS), Patricia's total annual Medicare-related savings exceed $5,000.

Example 4: William 80 Augusta Continuous SEP plan change

William, 80, lives in Augusta. SLMB beneficiary enrolled in a WellCare Dual Liberty D-SNP since January 2026. In May 2026, William becomes frustrated with care coordination issues: he's been unable to schedule a follow-up appointment with his cardiologist, the plan's customer service has been unresponsive, and his prescriptions have been delayed multiple times.

William calls GeorgiaCares. The counselor reviews William's situation:

• Plan change available during Continuous SEP (Q2: April 1 - June 30)
• William has used zero plan changes so far in 2026; Q1, Q2, Q3, AEP all available
• Other D-SNP options in Augusta: UnitedHealthcare Dual Complete (4.5 stars), Humana Gold Plus D-SNP (4 stars), Aetna Medicare Dual Eligible (3.5 stars)

The counselor compares the options and finds that William's cardiologist is in-network for UnitedHealthcare and Humana but not for WellCare. The counselor also notes that William's primary care physician is in-network for all three. The counselor processes the switch to UnitedHealthcare Dual Complete effective June 1, 2026.

William has used one of his quarterly plan changes. He has Q3 and AEP remaining if needed. The new plan handles his transition: prior authorization records transfer through the Medicare claims system, his prescriptions resume, and his cardiology appointment is scheduled within two weeks.

Example 5: Susan 70 Columbus disenrollment to Original Medicare

Susan, 70, lives in Columbus. QMB beneficiary enrolled in a Humana D-SNP. Susan develops a complex medical condition requiring specialist care. Her preferred specialist (at Emory University in Atlanta) is out of the D-SNP network. The D-SNP requires referrals to in-network specialists, and Emory is not affiliated with any of the available D-SNPs in Susan's region.

Susan calls GeorgiaCares. The counselor explains her options:

1. Stay in D-SNP: see the in-network specialists assigned by the plan (limits Susan's options)
2. Switch to a different D-SNP: but no available Columbus-region D-SNP includes Emory
3. Disenroll to Original Medicare + PDP: provides access to any Medicare-accepting provider including Emory, but loses dental, vision, hearing benefits

Susan chooses Original Medicare for the specialist access. Disenrollment is processed during the MA Open Enrollment Period (Q1, January 1 - March 31, 2026; one switch allowed). Susan returns to Original Medicare with a stand-alone Part D plan. Her QMB coverage continues through Medicaid: Medicare cost-sharing remains covered. Her Part D plan applies LIS rules ($4.90 generic, $12.15 brand). She loses dental, vision, hearing, OTC, transportation, and gym benefits.

Susan's annual loss from leaving the D-SNP: approximately $3,000 in supplemental benefits. Gain: access to Emory specialist care. For Susan, the gain outweighs the loss.

In 2027, after specialist treatment concludes, Susan could re-enroll in a D-SNP during AEP if she chooses.

Example 6: Joseph 78 Athens HIDE-SNP nursing facility resident

Joseph, 78, lives in Athens. Full Benefit Dual Eligible (FBDE) enrolled in a Humana HIDE-SNP that covers behavioral health services through a Medicaid managed care contract operated by Humana's parent organization. In April 2026, Joseph enters Pruitt Health nursing facility due to mobility decline after a hip fracture.

The HIDE-SNP provides:

• Medicare coverage: acute care hospitalization, skilled nursing facility days 1-100 with intensive rehabilitation
• Part D: $0 copay under Section 1860D-14 nursing facility rule
• Behavioral health: integrated through the Medicaid managed care contract, addressing Joseph's depression after the fracture
• Care coordination: single care coordinator from Humana coordinates the nursing facility care plan, Medicare-covered acute services, and behavioral health

Long-term nursing facility care after Medicare SNF benefit exhaustion is covered by Georgia Medicaid fee-for-service (since this is a HIDE-SNP, not a FIDE-SNP, and LTSS is not covered by the plan). Joseph's care coordinator from the HIDE-SNP works with the nursing facility and DCH to ensure smooth transition between Medicare-covered acute and rehabilitation services and Medicaid-covered long-term care.

The HIDE-SNP integration provides smoother care than a Coordination-Only D-SNP would, but less seamless than a true FIDE-SNP because LTSS remains in fee-for-service Medicaid.

State Medicaid Agency Contract Requirements in Georgia

DCH requires all D-SNPs operating in Georgia to have a State Medicaid Agency Contract. The 2026 Georgia SMAC includes the following elements aligned with the CMS Final Rule.

Cost-Sharing Protections

D-SNPs cannot charge dual eligibles for Medicare cost-sharing. For QMB enrollees specifically, Section 1902(n) of the Social Security Act prohibits all balance billing. The SMAC reinforces these protections with contract-level enforcement.

Information Sharing

Monthly file exchange between the D-SNP and DCH to:

• Identify enrolled members
• Verify dual eligible status
• Coordinate buy-in for Medicare premiums
• Reconcile cost-sharing claims

Care Coordination Standards

Minimum care coordination requirements:

• Health Risk Assessment at enrollment and annually
• Individualized Care Plan for all members
• Care coordinator assignment for high-risk members
• Coordination with Medicaid LTSS, behavioral health, and community services

Network Adequacy

D-SNP provider networks must meet CMS standards covering:

• Primary care physician access
• Specialist access (cardiology, oncology, behavioral health, etc.)
• Pharmacy access
• Hospital and skilled nursing facility access
• Time and distance standards for rural areas

Grievance and Appeals

Integrated grievance and appeals process consistent with federal rules. For HIDE-SNPs and FIDE-SNPs, integrated appeals across Medicare and Medicaid (one process instead of separate Medicare and Medicaid appeals).

Marketing Standards

D-SNP marketing must follow CMS rules including:

• Prohibition on agents misrepresenting plans
• Clear distinction between D-SNP and standard MA
• Accurate supplemental benefit descriptions
• Prohibition on cold-calling dual eligibles
• Marketing material approval by CMS and DCH

Disenrollment Coordination

D-SNP must inform DCH of disenrollments and assist with continuity of care during transitions.

Reporting and Oversight

Annual quality and performance reports to DCH, including:

• HEDIS measures
• CAHPS satisfaction scores
• Star ratings
• Complaint and grievance data
• Care coordination outcomes

How to Choose a D-SNP in Georgia

For Georgia dual eligibles considering a D-SNP, the decision involves several factors.

Step 1: Verify Eligibility

Confirm you are a dual eligible:

• Enrolled in Medicare Part A and Part B
• Enrolled in Georgia Medicaid (FBDE, QMB, SLMB, or QI)
• Resident of a Georgia county served by at least one D-SNP

If you don't have Medicaid, you can't enroll in a D-SNP. Apply for MSP or full Medicaid first through Georgia Gateway or DFCS.

Step 2: List Your Priorities

Different priorities lead to different plans:

• Care coordination and integration: choose HIDE-SNP or FIDE-SNP if available
• Specific providers: choose the D-SNP that includes your preferred providers in-network
• Specific medications: choose the D-SNP whose formulary covers your medications at the lowest tier
• Dental coverage: compare dental annual caps and covered services
• Hearing aid coverage: compare hearing aid allowances
• Transportation: compare annual one-way trip allowances
• Star rating: higher-rated plans typically have better quality

Step 3: Compare Plans

Use medicare.gov/plan-compare to compare D-SNPs available in your county. Filters:

• Plan type: Special Needs Plan (Dual Eligible)
• Your prescriptions
• Your preferred providers
• Star ratings

GeorgiaCares (1-866-552-4464) provides free unbiased comparison counseling.

Step 4: Verify Your Providers and Medications

Before enrolling, confirm:

• Primary care physician in-network
• Key specialists in-network
• All medications on formulary at acceptable tier
• Preferred pharmacy in-network

Step 5: Enroll During an Appropriate Window

Use one of the available enrollment windows:

• Continuous SEP (quarterly for dual eligibles)
• AEP (October 15 - December 7 for January 1 effective)
• MA OEP (January 1 - March 31, one switch)
• IEP (if newly 65)
• 5-star SEP (if enrolling in a 5-star plan)

Enroll through:

• 1-800-MEDICARE
• medicare.gov/plan-compare
• Directly with the carrier (online or by phone)
• GeorgiaCares assistance

Step 6: Annual Review

Each year during AEP (October 15 - December 7), review your D-SNP options:

• Has your plan's network changed?
• Have your plan's supplemental benefits changed?
• Has your formulary changed?
• Have new D-SNPs entered your market?
• Are there better plans for your medications or providers?

GeorgiaCares can review your plan annually for free.

Common Mistakes Georgia Families Make

1. Enrolling in standard MA instead of D-SNP: standard MA may not coordinate with Medicaid; D-SNPs are specifically designed for dual eligibles

2. Choosing based on supplemental benefits alone: provider network and prescription formulary matter more for total cost and access

3. Not understanding the Continuous SEP: dual eligibles can change plans up to four times per year, much more flexible than standard Medicare

4. Missing the disenrollment window: leaving a D-SNP requires using a valid SEP, AEP, or MA OEP

5. Not coordinating Medicaid services: in Coordination-Only D-SNPs, Medicaid LTSS and waivers are accessed separately

6. Confusing D-SNP carrier brand names: each carrier has multiple D-SNP product lines with similar names; read the Evidence of Coverage carefully

7. Provider network surprises: confirm your preferred providers are in-network before enrolling

8. Not maintaining Medicaid status: D-SNP enrollment depends on continued Medicaid eligibility; redetermination matters

9. Aggressive marketing tactics: D-SNP agents sometimes use high-pressure marketing; verify all claims with GeorgiaCares before enrolling

10. Not engaging GeorgiaCares for plan selection: SHIP counselors provide unbiased D-SNP comparison

11. Assuming all D-SNPs are equal: integration tier (Coordination-Only vs HIDE-SNP vs FIDE-SNP) affects experience substantially

12. Not reading the Evidence of Coverage: specific benefit rules, cost-sharing, exclusions, and prior authorization requirements

13. Missing annual reviews: D-SNP benefits change each year; annual review during AEP is essential

14. Confusing D-SNP with PACE: PACE is a separate program for very frail elders meeting nursing facility level of care

15. Not pursuing FIDE-SNP when available: FIDE-SNPs offer the best integration but are limited in Georgia

Frequently Asked Questions

::: accordion

What is a D-SNP?

A Dual Eligible Special Needs Plan (D-SNP) is a Medicare Advantage plan authorized under Section 1859(b)(6)(B)(ii) of the Social Security Act that enrolls only Medicare beneficiaries also enrolled in state Medicaid. D-SNPs integrate Medicare Part A, Part B, and Part D benefits with coordination of Medicaid benefits, providing dual eligibles with more coordinated care than separate Medicare and Medicaid coverage.

Who can enroll in a D-SNP in Georgia?

Medicare beneficiaries who are also enrolled in Georgia Medicaid through one of the qualifying categories: Full Benefit Dual Eligible (FBDE), Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), or Qualifying Individual (QI). Each D-SNP specifies which categories it accepts; some are FBDE-only.

What are the 2026 Georgia D-SNP carriers?

Major 2026 Georgia D-SNP carriers include Humana (Humana Gold Plus and Humana Honor), WellCare (WellCare Dual Liberty), UnitedHealthcare (UHC Dual Complete), Aetna (Aetna Medicare Dual Eligible), Anthem (Wellpoint Dual Advantage), and Centene. Cigna, Alignment Healthcare, and Devoted Health operate in selective markets. Plan availability varies by county.

What is the difference between a D-SNP, HIDE-SNP, and FIDE-SNP?

A Coordination-Only D-SNP covers Medicare benefits and coordinates with Medicaid but doesn't cover Medicaid services directly. A HIDE-SNP covers Medicare plus some Medicaid services (typically LTSS or behavioral health) through a Medicaid managed care contract operated by the same parent organization. A FIDE-SNP covers Medicare and comprehensive Medicaid benefits through a unified plan structure. In Georgia, Coordination-Only D-SNPs are most common.

What does a D-SNP typically cost?

For Georgia dual eligibles, D-SNPs typically have $0 premium, $0 deductible, $0 medical copays (Medicare cost-sharing covered by Medicaid through QMB or FBDE relationship), and $0 Part D premium (Extra Help applies automatically). Medical and prescription costs are minimal.

What supplemental benefits do D-SNPs offer?

Typical D-SNP supplemental benefits include dental ($1,000-$3,000 annual cap), vision allowance ($100-$300), hearing aid allowance ($500-$3,000 per ear), quarterly OTC allowance ($50-$500), post-hospitalization meals, non-emergency medical transportation (24-48 trips), SilverSneakers gym membership, and flex card spend allowance. Specific benefits vary by carrier and county.

How do I enroll in a D-SNP?

Through 1-800-MEDICARE, medicare.gov/plan-compare, or directly with the carrier. GeorgiaCares (1-866-552-4464) provides free counseling and can process enrollment. You must be a dual eligible (Medicare + Georgia Medicaid).

When can I enroll in a D-SNP?

Dual eligibles have a Continuous Special Enrollment Period under 42 CFR 422.62(b)(5) allowing one plan change per quarter for Q1, Q2, Q3, plus one change during Annual Election Period for Q4. Total: up to four changes per year. You can also enroll during your Initial Enrollment Period (around your 65th birthday) or other valid Special Enrollment Periods.

How do I disenroll from a D-SNP?

Switch to another D-SNP during a Continuous SEP quarter, switch to a standard MA plan during AEP or MA OEP, or switch to Original Medicare plus a stand-alone PDP during AEP or MA OEP. If you lose Medicaid status, the D-SNP either moves you to a similar non-D-SNP plan or disenrolls you to Original Medicare, with a 6-month grace period during which you can regain Medicaid.

What happens if I lose Medicaid eligibility?

The D-SNP applies a 6-month grace period during which you can regain Medicaid status (e.g., through Pickle Amendment, asset spend-down, or redetermination correction). During the grace period, you stay in the D-SNP. After 6 months, you're moved to a similar non-D-SNP plan or to Original Medicare.

How does a D-SNP coordinate with my Medicaid services?

In a Coordination-Only D-SNP, your Medicaid services (LTSS, waivers, behavioral health) are accessed separately through Georgia fee-for-service Medicaid or limited Medicaid managed care. The D-SNP coordinates with DCH on cost-sharing and information sharing but doesn't directly cover Medicaid services. In a HIDE-SNP or FIDE-SNP, the plan covers some or all Medicaid services directly.

Are my doctors in the D-SNP network?

You must verify before enrolling. Use medicare.gov/plan-compare to check the D-SNP's provider directory, or contact the plan directly. GeorgiaCares can also verify network membership for your providers.

Are my medications covered by the D-SNP?

D-SNPs include Part D coverage with their own formularies. You must verify your medications are on the formulary at an acceptable tier before enrolling. Extra Help applies automatically (no Part D premium, $0 deductible, $4.90 generic / $12.15 brand copays, $0 in nursing facility).

What is the State Medicaid Agency Contract?

The State Medicaid Agency Contract (SMAC) under 42 CFR 422.107 is the required written contract between every D-SNP and the state Medicaid agency (DCH for Georgia). It covers cost-sharing protections, information sharing, care coordination, network adequacy, beneficiary protections, marketing standards, disenrollment, and reporting. DCH publishes a SMAC template that 2026 Georgia D-SNPs follow.

What's the difference between a D-SNP and PACE?

PACE (Programs of All-Inclusive Care for the Elderly) is a separate program for very frail elders meeting nursing facility level of care criteria. PACE provides comprehensive Medicare and Medicaid services through a single program with a multidisciplinary team and adult day care center. D-SNPs serve a broader population of dual eligibles, not limited to NF level of care.

Can I have a D-SNP if I have a Medigap plan?

No. Medigap (Medicare Supplement Insurance) works with Original Medicare, not Medicare Advantage. If you enroll in a D-SNP (which is an MA plan), you cannot use Medigap simultaneously, and your Medigap would no longer be needed because the D-SNP covers cost-sharing.

What if I'm enrolled in a standard MA plan and want to switch to a D-SNP?

You can switch during an appropriate election period. As a dual eligible, you have the Continuous SEP for quarterly plan changes (Q1, Q2, Q3 plus AEP). Use 1-800-MEDICARE or GeorgiaCares to process the switch.

How does the 2024 CMS Final Rule affect D-SNPs in 2026?

The April 2024 CMS Final Rule strengthens D-SNP integration with new requirements for FIDE-SNPs to cover Medicaid behavioral health, standardized integration tier definitions, network adequacy standards, enhanced care coordination requirements, and marketing rule changes. Effective Plan Year 2026.

What is the Health Risk Assessment (HRA)?

D-SNPs are required to conduct a Health Risk Assessment for every member at enrollment and annually. The HRA covers medical history, functional status, mental health, social determinants of health, and care needs. The HRA results inform the Individualized Care Plan and care coordinator assignments.

What is the Individualized Care Plan?

Based on the HRA, the D-SNP develops an Individualized Care Plan (ICP) for each member. The ICP outlines health goals, care interventions, coordination needs, and member preferences. High-risk members receive a dedicated care coordinator. The ICP is updated at least annually.

How do D-SNP appeals work?

D-SNPs follow the Medicare Advantage appeals process under 42 CFR Part 422 Subpart M. For HIDE-SNPs and FIDE-SNPs, there's an integrated appeals process that combines Medicare and Medicaid appeals under the 2024 CMS Final Rule. Beneficiaries have specific timeframes (typically 60 days) to file appeals. GeorgiaCares can assist with appeals.

Can I have a D-SNP and supplemental insurance?

D-SNPs are typically comprehensive enough that supplemental insurance isn't needed. The plan covers Medicare A, B, D plus supplemental benefits. Adding additional insurance is usually unnecessary and creates coordination complexity.

Can I travel with a D-SNP?

D-SNPs are HMO or PPO plans with regional service areas. Routine care while traveling outside the service area may not be covered. Emergency and urgent care are typically covered nationwide. If you travel frequently, Original Medicare provides more flexibility.

How do I report problems with a D-SNP?

For grievances or appeals about the D-SNP itself, contact the plan's member services. For complaints about marketing, file with Medicare at 1-800-MEDICARE. For systemic issues, contact GeorgiaCares (1-866-552-4464) or Medicare Rights Center (1-800-333-4114). Atlanta Legal Aid (404-377-0701) and Georgia Legal Services (1-800-498-9469) handle severe access issues.

Where can I get help comparing D-SNPs in Georgia?

GeorgiaCares (SHIP), 1-866-552-4464. SHIP counselors are trained in D-SNP comparison, formulary matching, and provider network verification. The service is free and unbiased. Also available: Medicare 1-800-MEDICARE, Medicare Rights Center 1-800-333-4114, DAS Aging and Disability Resource Connection 1-866-552-4464. :::

Where to Get Help

::: cta D-SNP Resources in Georgia

• Medicare (enrollment): 1-800-MEDICARE (1-800-633-4227)
• medicare.gov/plan-compare: official plan comparison
• GeorgiaCares (SHIP): 1-866-552-4464 (top resource for D-SNP plan selection)
• Georgia DCH Medicaid Member Services: 1-866-211-0950
• Georgia DFCS Customer Service: 1-877-423-4746
• Georgia DAS Aging and Disability Resource Connection: 1-866-552-4464
• Medicare Rights Center: 1-800-333-4114
• Humana Customer Service: 1-800-457-4708
• UnitedHealthcare Customer Service: 1-877-542-9236
• Aetna Customer Service: 1-855-463-0933
• WellCare Customer Service: 1-866-799-5318
• Atlanta Legal Aid Senior Citizens Law Project: 404-377-0701
• Georgia Legal Services Program: 1-800-498-9469
• AARP Georgia: 1-866-295-7283
• Eldercare Locator: 1-800-677-1116
• 211 Georgia: dial 211 for community resources :::

Dual Eligible Special Needs Plans are among the most valuable Medicare Advantage options available to Georgia dual eligibles. For 2026, the combination of $0 premium, $0 medical copays (Medicare cost-sharing covered through QMB or FBDE), integrated Part D with automatic Extra Help, and substantial supplemental benefits (dental, vision, hearing, OTC, transportation, gym) makes D-SNPs the default choice for most Georgia dual eligibles unless specific provider access needs or travel patterns favor Original Medicare. The choice between Coordination-Only D-SNPs, HIDE-SNPs, and FIDE-SNPs depends on the available options in the beneficiary's county; in most Georgia counties, Coordination-Only D-SNPs are the primary option.

Brevy (brevy.com) maintains comprehensive Georgia Medicare and Medicaid coverage including D-SNPs, the Medicare Savings Programs (QMB, SLMB, QI, QDWI), Medicare Part D Low-Income Subsidy (Extra Help), Aged Blind and Disabled Medicaid, Full Benefit Dual Eligible status, the Pickle Amendment, and the Community Care Services Program waiver. For dual eligible Georgia families navigating plan selection, the GeorgiaCares SHIP counselors at 1-866-552-4464 provide free unbiased counseling and can compare every available D-SNP in your county.

Find personalized help navigating Georgia D-SNP options at brevy.com.

This guide is for informational purposes only and does not constitute legal, financial, medical, insurance, or tax advice. D-SNP eligibility, plan selection, and enrollment involve specific factual circumstances. Consult Medicare, GeorgiaCares, your D-SNP carrier, or qualified counsel for case-specific guidance. Information is current as of May 2026; plan availability, benefits, networks, and federal poverty levels change annually. Plan year 2026 benefits and carriers may change in 2027 and beyond.