Georgia Medicare D-SNPs Dual-Eligible Special Needs Plans 2026

If you have both Medicare and Medicaid in Georgia, a Dual-Eligible Special Needs Plan (D-SNP) is a Medicare Advantage plan built for you. It covers your Medicare hospital, medical, and drug benefits, adds care coordination meant to bridge Medicare and Medicaid, and may add extra benefits, while Medicaid picks up Medicare cost-sharing for people in the QMB program.1,2 This guide covers who qualifies, how the three D-SNP subtypes differ, when you can enroll, and how to find the plans offered in your county. Dual eligibles are people who qualify for Medicare because of age (65+) or disability and who also have low enough income and assets to qualify for some form of Medicaid in Georgia (full Medicaid for the lowest-income, or one of the Medicare Savings Programs (QMB, SLMB, QI) for slightly higher-income beneficiaries).

Why D-SNPs Matter for Georgia's Dual Eligibles

Dual eligibles face a uniquely complex healthcare landscape. They must navigate two separate insurance programs with different rules, different provider networks, different appeals processes, different copayment structures, and different covered services. Without coordination, dual eligibles often receive duplicative or fragmented care, miss preventive services, and fall through cracks in the safety net.

The federal solution to this complexity is the Dual-Eligible Special Needs Plan, a Medicare Advantage plan type designed exclusively for dual eligibles. A D-SNP bundles Medicare benefits with care coordination services that bridge Medicare and Medicaid, providing dual eligibles with:

• A single Medicare Advantage plan that delivers all Medicare benefits
• A care coordinator who helps navigate both Medicare and Medicaid
• Possible extra benefits, such as dental, vision, hearing, or transportation, which vary by plan1
• Often $0 out-of-pocket costs for in-network care, because Georgia Medicaid pays Medicare cost-sharing for Qualified Medicare Beneficiaries2
• Coordination with Medicaid for the services Medicaid covers but Medicare does not, such as home-based long-term services and supports3

D-SNPs are offered in 47 states and the District of Columbia in 2026; the only states with none are Alaska, New Hampshire, and Vermont.6 Which ones you can join in Georgia depends on your county, because insurers decide where they do business.1

This guide walks through Georgia's D-SNP options: the federal rules, the three D-SNP subtypes (Coordination-Only, HIDE-SNP, FIDE-SNP), the eligibility requirements, the enrollment windows, the benefit structure, the care coordination requirements, how to find the plans offered where you live, and a practical framework for deciding whether a D-SNP fits.

The Federal Rules Behind D-SNPs

What federal regulation calls a D-SNP

Under 42 CFR 422.2, a D-SNP is a specialized Medicare Advantage plan for special needs individuals who are entitled to medical assistance under a state's Medicaid plan.2 It is one of three types of Medicare Special Needs Plan, alongside Chronic Condition SNPs (C-SNPs) and Institutional SNPs (I-SNPs).1

The State Medicaid Agency Contract (SMAC)

Every D-SNP must have a contract with the state Medicaid agency, which CMS calls the State Medicaid Agency Contract (SMAC) or MIPPA contract. Under 42 CFR 422.107, that contract must at a minimum document:3

1. The plan's responsibility to coordinate Medicaid benefits for members eligible for them and, if applicable, to cover Medicaid services such as long-term services and supports
2. The categories and criteria that decide which dual eligibles the plan may enroll
3. The Medicaid benefits covered under any capitated contract between the state and the plan's organization
4. The cost-sharing protections the plan covers
5. How information on Medicaid provider participation is identified and shared
6. How the plan verifies each member's Medicaid eligibility
7. The plan's service area
8. The contract period3

That list is why two Georgia D-SNPs can accept different Medicaid categories and cover different counties: those terms are set plan by plan in each contract.3

In Georgia, D-SNP contracting runs through the Georgia Department of Community Health (DCH). DCH announced it would place a moratorium on contracting with any new D-SNPs starting August 1, 2025, to comply with the federal D-SNP integration requirements, with updates to come once it has redefined its future approach.1

The 2027 integration rules

The federal integration requirements DCH cited take effect in 2027. Beginning that year, where an insurer, or a company under the same parent, also holds a contract with the state as a Medicaid managed care organization enrolling full-benefit dual eligibles in the same service area, it may generally offer only one D-SNP for full-benefit dual eligibles there and must limit new enrollment to people enrolled in, or enrolling in, its Medicaid plan, subject to listed exceptions.7

The Three D-SNP Subtypes

Subtype 1: Coordination-Only D-SNPs

A coordination-only D-SNP covers your Medicare benefits, including Part D drug coverage, and coordinates your Medicaid benefits, but it does not deliver them.1,3 Your Georgia Medicaid coverage stays separate: home-based long-term care, for example, still comes through Medicaid's CCSP and SOURCE waivers.1

In Georgia: Georgia is not on CMS's 2025 or 2026 list of states offering integrated D-SNPs (FIDE-SNPs, HIDE-SNPs, or other applicable integrated plans), so the D-SNPs offered in Georgia in those years are coordination-only plans.4

What it means for you: You still deal with two programs. The plan's care coordinator can help you connect to Medicaid services, but you apply for and keep those services through Georgia Medicaid.

Subtype 2: Highly Integrated Dual-Eligible SNPs (HIDE-SNPs)

A HIDE-SNP is an integrated D-SNP: it is paired with a Medicaid managed care plan, and the federal Integrated Care SEP exists to align a member's Medicare and Medicaid enrollment with the same organization.4 A HIDE-SNP with exclusively aligned enrollment counts as an "applicable integrated plan," which combines Medicare and Medicaid grievances and appeals into a single process rather than two separate tracks.2

In Georgia: Georgia is not on CMS's 2025 or 2026 list of states offering HIDE-SNPs, FIDE-SNPs, or other applicable integrated plans. The list changes each contract year, so check CMS's 2027 list (or ask GeorgiaCares) before assuming one is available where you live.4

Subtype 3: Fully Integrated Dual-Eligible SNPs (FIDE-SNPs)

A FIDE-SNP is the most integrated form. Under 42 CFR 422.2, it is run by a single organization that holds both the Medicare Advantage contract and a capitated Medicaid managed care contract with the state covering primary and acute care and long-term services and supports, to the extent the state's Medicaid program covers them.2 Like an exclusively aligned HIDE-SNP, it handles Medicare and Medicaid grievances and appeals through one integrated process.2

In Georgia: Georgia is not on CMS's 2025 or 2026 list of states offering FIDE-SNPs.4

Georgia D-SNP Eligibility Requirements

Medicare Eligibility

D-SNP enrollees must be enrolled in Medicare Part A and Part B. (Part A only is not sufficient; both parts are required.)1

Medicaid Eligibility

You also need Georgia Medicaid in a category the plan accepts. The dual eligibility categories are:

1. Full-benefit dual eligibles: QMB-Plus, SLMB-Plus, and other full-benefit dual eligibles (FBDE) who have full Georgia Medicaid
2. Partial-benefit dual eligibles: QMB, SLMB, QI, and QDWI, the Medicare Savings Program groups without full Medicaid4

Which of these a particular D-SNP may enroll is not set by one federal list. The plan's contract with the state must spell out the categories and criteria for the dual eligibles it enrolls, so confirm with the plan, or with GeorgiaCares, that it accepts your category before you apply.3

Residency

You must live in the plan's service area, and you must keep living there: a plan can, and in some cases must, disenroll you if you move outside it. Service areas are set plan by plan, and because insurers decide where they do business, a D-SNP offered in one Georgia county may not be offered in the next.1

Enrollment Verification

The plan's contract with the state must cover how the plan verifies each member's Medicaid eligibility.3 If the plan finds you no longer meet its eligibility criteria but can reasonably be expected to regain them within six months, federal rules deem you still eligible for a period the plan chooses, of at least 30 days and no more than six months. If you do not requalify within that period, the plan is expected to disenroll you at its end, and it should send a disenrollment notice at least 30 days beforehand.8

How to Enroll in a Georgia D-SNP

Special Enrollment Periods (SEPs) for Dual Eligibles

This is the part of D-SNP enrollment most often described wrongly, including by plan marketing, so it is worth getting exactly right. Effective January 1, 2025, the contract year 2025 Medicare Advantage and Part D final rule (CMS-4205-F) retired the old quarterly dual-eligible SEP and replaced it with two separate once-monthly SEPs. Neither is a general "switch to any Medicare Advantage plan in any month" right.4

The Dual/LIS SEP. Usable once per month by full-benefit dual eligibles (QMB-Plus, SLMB-Plus, FBDE), by partial-benefit dual eligibles (QMB, SLMB, QI, QDWI), and by people who have Extra Help without Medicaid. It lets you elect original Medicare plus a standalone Part D drug plan, or switch from one standalone drug plan to another. That is also the route for dropping a Medicare Advantage plan with drug coverage and returning to original Medicare. It is not available to anyone identified as an at-risk or potential at-risk beneficiary under a Part D drug management program.4

The Integrated Care SEP. Usable once per month by full-benefit dual eligibles only, not by partial-benefit duals and not by people with Extra Help alone. It lets you enroll in a FIDE-SNP, a HIDE-SNP, or another applicable integrated plan, and it exists to align your Medicare and Medicaid enrollment with the same organization. If you stay in Medicaid fee-for-service or in a Medicaid managed care plan that is not aligned with the D-SNP, you cannot use it, though being in fee-for-service today does not by itself rule you out if you are eligible for, and want to join, the aligned Medicaid plan. It also depends on where you live, because an integrated plan has to be offered in your area.4

Elections made under either SEP take effect on the first day of the following month.

What the SEPs Mean in Georgia

Read the two SEPs against Georgia's market and the practical answer changes. CMS marks each D-SNP as eligible for the Integrated Care SEP or not, and most coordination-only D-SNPs are not (the exceptions CMS lists are some California plans). CMS's lists of states offering FIDE-SNPs, HIDE-SNPs, and applicable integrated plans did not include Georgia for 2025 or 2026. Those lists change every contract year, so for a move that would take effect in 2027, check CMS's 2027 integrated D-SNP list on its D-SNP page before you rule the Integrated Care SEP in or out. Neither SEP permits enrollment into, or switching between, non-D-SNP Medicare Advantage plans. Dual eligibles can still choose any Medicare Advantage plan during their Initial Enrollment Period, the fall Medicare Open Enrollment Period, the Medicare Advantage Open Enrollment Period, and any other SEP they separately qualify for, and for most Georgia D-SNPs those are the windows that actually apply. Before you count on a mid-year switch, ask the plan or GeorgiaCares whether it is an integrated plan.4

Default Enrollment

Federal rules let a D-SNP "default enroll" someone who is newly eligible for Medicare and already in that insurer's affiliated Medicaid managed care plan, but only when the state has approved it in its contract with the D-SNP, CMS has approved the insurer, and the person has received a notice at least 60 days ahead and has not declined. You can decline at any time up to the day before it takes effect and choose original Medicare or another plan instead.9 If a notice says you are being placed in a D-SNP, call GeorgiaCares before the effective date to talk through your choice.

Enrollment Methods

Beneficiaries can enroll in a D-SNP through:

1. The plan itself, by contacting the insurer directly
2. Medicare Plan Finder at medicare.gov
3. An insurance broker or agent
4. GeorgiaCares SHIP at 1-866-552-4464, option 4, for free, unbiased help understanding your plan choices and enrolling5

What Happens If You Lose Medicaid

A D-SNP depends on continued Medicaid eligibility, so keeping up with your annual Medicaid redetermination is the single most important thing you can do to protect the plan. If your Medicaid or Medicare Savings Program status lapses and you can reasonably be expected to regain it within six months, the plan keeps treating you as eligible for a period it chooses, between 30 days and six months.8 If you cannot restore it, you cannot stay in the D-SNP, and Medicare.gov says someone who loses a plan this way may be eligible for a Special Enrollment Period to join another plan.1

One coordination trap is worth planning for before it happens. A D-SNP cannot be paired with a Medigap policy, because Medigap helps pay costs in original Medicare, not Medicare Advantage, and a D-SNP is a Medicare Advantage plan.10 Georgia follows the federal Medigap rule: your guaranteed-issue window is the six months that begin when you are both 65 or older and enrolled in Part B, and Georgia's Medigap regulation contains no annual "birthday rule" or any other yearly state guaranteed-issue window for switching plans. Once that six-month window closes, CMS warns there is no guarantee an insurer will sell you a policy if you don't meet its medical underwriting requirements, unless you have a guaranteed-issue right. In Georgia those rights are triggered by events, not dates, and the events in the state's regulation include certain situations for people enrolled in a Medicare Advantage plan. So a dual eligible who later leaves a D-SNP for original Medicare, whether by choice or because Medicaid lapsed, should ask GeorgiaCares whether that move counts as a guaranteed-issue event before applying, because without one the insurer can turn them down. Georgia does separately require insurers to offer at least one kind of Medigap policy to people with Medicare under 65, which matters because many dual eligibles qualify for Medicare through disability rather than age, though CMS notes that states differ in the scope of this right and that you'll probably have more options and a lower premium once your Medigap Open Enrollment Period opens at 65, so confirm the specific plan letters and terms with GeorgiaCares or the Georgia Office of Commissioner of Insurance and Safety Fire.11 While you hold QMB (including QMB-Plus) the point is largely moot, since Medicare providers may not bill you for Medicare cost-sharing; the risk appears only if that protection ends.2

D-SNP Benefit Structure

Core Medicare Advantage Benefits

D-SNPs provide all standard Medicare Advantage benefits:

• Part A (hospital insurance)
• Part B (medical insurance)
• Part D (prescription drugs), which every SNP must include1
• Out-of-pocket maximum (CMS sets a limit plans may not exceed, $9,250 for in-network Part A and Part B cost sharing in 2026, and plans may set lower limits; the cap does not cover Part D drug spending)12

Medicare Cost-Sharing Payment for QMB

For QMB beneficiaries enrolled in a D-SNP, Georgia Medicaid pays the Medicare cost-sharing (deductibles, coinsurance, copayments).13 Because federal law prohibits providers from billing Qualified Medicare Beneficiaries for Medicare cost-sharing, QMB D-SNP enrollees typically have $0 or near-$0 out-of-pocket costs for in-network care.2

Extra Benefits Vary by Plan

Medicare.gov says SNPs might also cover extra services for the groups they serve, which is a possibility, not a requirement.1 Extras worth checking for include dental, vision, hearing aids, an over-the-counter allowance, rides, meals, and fitness memberships, but whether a plan covers any of them, and how much, is that plan's choice and can change every year. Read the plan's Summary of Benefits for the year before you rely on one.

Medicaid Wrap

Your Georgia Medicaid coverage continues alongside the D-SNP for services Medicaid covers.1 Georgia Medicaid delivers home-based long-term services and supports separately from Medicare Advantage, through the Elderly & Disabled Waiver Program's Community Care Services Program (CCSP) and SOURCE. For people who qualify for a nursing facility level of care and meet the waivers' income, resource, and other criteria, those waivers provide case management, adult day care, alternative living services, personal care, home-delivered meals, and respite for family caregivers.1

What Zero Cost-Sharing Really Means

Georgia D-SNP marketing tends to blur two different $0 claims together, and only one of them is a guarantee written into law. Knowing which is which protects you from a surprise if a plan's premium ever changes.2

The guaranteed part is Medicare Part A and Part B cost-sharing. Medicare providers are not allowed to bill people in the QMB group for services and items Medicare covers, including deductibles, coinsurance, and copayments, so a QMB-enrolled D-SNP member faces $0 for those amounts no matter which plan they pick. Part D drugs are a separate matter, and the guarantee does not extend to them: Extra Help zeroes out the Part D deductible and pays your Part D premium in full on a benchmark plan, though on a plan priced above the regional benchmark you pay the difference.14 It does not zero out drug copays. The $0 monthly premium that plans advertise is a third thing again, a plan-design feature that varies by plan and year rather than a protection guaranteed by law.2

The cost-sharing that Medicaid absorbs on your behalf is real money. For 2026, Medicare carries a $1,736 Part A inpatient hospital deductible per benefit period and a $283 Part B annual deductible, after which a beneficiary normally pays 20% coinsurance on most Part B services, plus the $202.90 standard monthly Part B premium. Most people owe no Part A premium because they have at least 40 quarters of Medicare-covered work; those who must buy Part A pay $311 per month in 2026 if they or a spouse have at least 30 quarters of coverage, while certain people with fewer than 30 quarters on either record pay $565 per month. For a QMB-enrolled D-SNP member, Medicaid picks up those amounts, which is why the plan can feel free even though the underlying bills are not.12

On the drug side, anyone with full Medicaid or a Medicare Savings Program (QMB, SLMB, or QI) is automatically treated as eligible for full Extra Help (the Part D Low-Income Subsidy) and does not need to apply; QDWI enrollees are not. Under Extra Help in 2026, the most an enrollee pays is $5.10 for a covered generic and $12.65 for a covered brand-name drug, and $0 once out-of-pocket drug costs reach the $2,100 threshold. The former partial-subsidy tier was eliminated in 2024, so everyone who qualifies now receives the full subsidy.14

Full Medicaid can put you in a cheaper tier than that ceiling. In 2026, a full-benefit dual eligible with income at or below 100% of the poverty level pays up to $1.60 for a generic and $4.90 for a brand-name drug, and one who lives in an institution or gets home and community-based services pays $0. A full-benefit dual eligible with income between 100% and 150% of the poverty level, and anyone with QMB, SLMB, or QI but not full Medicaid, pays up to the $5.10 and $12.65 ceiling. Those are small numbers, but for most people they are not zero, and a plan that advertises "$0 prescriptions" is describing its premium and deductible, not your copay at the counter.2

Care Coordination Requirements

What Every SNP Must Do

Federal rules require every Special Needs Plan, D-SNPs included, to do the following:7

1. Initial health risk assessment: a comprehensive assessment within 90 days before or after your enrollment takes effect, covering your physical, psychosocial, and functional needs, with screening questions on housing stability, food security, and access to transportation
2. Annual reassessment: a comprehensive health risk assessment every year
3. Reaching you: at least three attempts to reach you, on different days and at different times, followed by a letter if you have not responded
4. Individualized care plan: a person-centered plan based on your own preferences and needs, built within 90 days of the initial assessment (or of your enrollment date, whichever is later)
5. Interdisciplinary care team: the care plan is developed through a team, with you or your representative taking part as feasible7

Integration with Medicaid

The D-SNP's contract with Georgia must spell out its responsibility to coordinate the delivery of Medicaid benefits for members who are eligible for them.3 In practice, that is the help to ask your care coordinator for when you need Medicaid services such as the Community Care Services Program (CCSP) or SOURCE waivers, which Georgia Medicaid runs separately from the D-SNP.1

Finding the D-SNPs Offered in Your County

Georgia's D-SNP lineup is set plan by plan and county by county. Insurers decide where they do business, so a D-SNP offered in one Georgia county may not be offered in the next, and the plans available can change from year to year.1 Rather than relying on a list of brand names, check what is actually offered at your address:

• Medicare Plan Finder: enter your ZIP code and filter for Special Needs Plans (Dual Eligible) to see each D-SNP offered there, its premium, and its network.
• GeorgiaCares: a counselor can walk through the D-SNPs offered in your county and how each one fits your doctors, drugs, and Medicaid category.5
• The plan's own documents: the Summary of Benefits and Evidence of Coverage list the year's extras, the provider directory lists the network, and the formulary lists covered drugs.

Decision Framework: Should a Dual Eligible Enroll in a D-SNP?

When to Choose a D-SNP

Strong fit for D-SNP if the beneficiary:

• Has full Medicaid (FBDE or QMB-Plus), so D-SNP maximizes value
• Wants integrated care coordination
• Values enhanced benefits (dental, vision, hearing, transportation, OTC)
• Has chronic conditions requiring multiple specialists
• Wants $0 or near-$0 out-of-pocket costs (Medicaid pays Medicare cost-sharing for QMB enrollees)2
• Has stable PCP and specialist relationships within the D-SNP's network
• Is comfortable with managed care
• Lives in an area with strong D-SNP network coverage

When to Choose Original Medicare and Medicaid Wrap

Better fit for original Medicare plus Medicaid if the beneficiary:

• Wants nationwide provider access (no network)
• Travels frequently
• Prefers fee-for-service flexibility
• Has providers not in any D-SNP network
• Lives in a rural area with limited D-SNP networks
• Prefers Medigap-like cost predictability (Medicaid wrap provides similar protection for QMB)
• Wants to avoid managed care prior authorizations

When a Standard MA Plan May Be Better Than a D-SNP

Possible if:

• Beneficiary prefers a specific MA plan with better network for them
• Beneficiary's PCP is not in any D-SNP
• Beneficiary lives in an area with no D-SNP

In these cases, the dual eligible can enroll in a standard MA plan during a window that allows it, and providers still may not bill a QMB enrollee for Medicare-covered cost-sharing.2

How to Choose a D-SNP in Georgia

The decision framework above sorts out whether a D-SNP is the right path for you. Once you have decided to enroll, these six steps turn that decision into a concrete plan.

GeorgiaCares, Georgia's State Health Insurance Assistance Program, is administered by the Georgia Division of Aging Services and gives free, unbiased help understanding your plan choices, enrolling in a plan, reviewing Medicare Summary Notices and Explanations of Benefits, sorting out medical bills, filing claims and appeals, and applying for the programs that lower your Medicare out-of-pocket costs. Its counselors are not affiliated with any insurance company and do not sell insurance. Reach a certified counselor Monday through Friday, 8 a.m. to 5 p.m., at 1-866-552-4464, option 4.5

14 Best Practices for D-SNP Enrollment

1. Compare plans annually: D-SNP benefits change each year; use Medicare Plan Finder during AEP
2. Check provider networks: verify your PCP and specialists are in the D-SNP network before enrolling
3. Verify Medicaid eligibility: confirm your Medicaid category (QMB, QMB-Plus, SLMB-Plus, FBDE) and that the plan accepts it before enrolling
4. Know which SEP you actually have: the once-monthly Integrated Care SEP reaches only integrated plans, and Georgia is not on CMS's 2025 or 2026 list of states offering them, so confirm before assuming a mid-year switch is available4
5. Get free help from GeorgiaCares SHIP: call 1-866-552-4464, option 4, for unbiased counseling5
6. Use the care coordinator: D-SNP care coordinators are valuable; engage with them proactively
7. Maintain Medicaid eligibility: renewals are crucial; loss of Medicaid means loss of D-SNP eligibility
8. Check enhanced benefits annually: dental, transportation, OTC allowances vary by plan
9. Review formulary annually: Part D formularies change; verify your medications are still covered
10. Understand prior authorization: D-SNPs require prior auth for some services; know the process
11. File appeals when denied: dual eligibles have strong appeal rights; use them
12. Coordinate with Medicaid for LTSS: Georgia Medicaid, not the D-SNP, runs the CCSP and SOURCE waivers; ask your care coordinator to help you apply1
13. Report provider balance billing: Medicare providers may not bill QMB enrollees for Medicare-covered deductibles, coinsurance, or copays2
14. Verify integration level: know whether your plan is C-D-SNP (most common in GA), HIDE-SNP, or FIDE-SNP

14 Common Issues with D-SNPs in Georgia

1. Loss of Medicaid eligibility: disenrollment from D-SNP follows; reapply for Medicaid promptly
2. Provider network confusion: out-of-network care may have unexpected costs
3. Switching mid-treatment: if you are getting treatment and switch plans, the new plan must give you at least 90 days before it can require a new prior approval for that ongoing treatment1
4. Prior authorization delays: specialist appointments and procedures may require prior auth
5. Care coordinator turnover: care coordinators sometimes change; maintain communication
6. Provider balance billing: providers may try to bill QMB enrollees in violation of federal law
7. No integrated D-SNPs on CMS's 2025 or 2026 lists: Georgia was not among the states CMS listed as offering HIDE-SNPs, FIDE-SNPs, or other applicable integrated plans in either year4
8. Out-of-network care: some SNPs cover only network care except for emergencies, out-of-area urgent care, and out-of-area dialysis, while others cover out-of-network care at a higher cost1
9. Annual plan changes: benefits and provider networks change each year
10. Confusion between the two programs: a D-SNP is a Medicare plan, and Georgia Medicaid delivers home-based long-term care separately through its waivers1
11. Dental benefit limits: even with generous dental benefits, some services exceed annual limits
12. Specialty drug coverage: some Part D specialty drugs require prior auth or are not covered
13. Transportation booking: rides arranged through a plan or through Medicaid have their own scheduling rules; ask how far ahead to book
14. Coordination gaps: even with care coordinator, some gaps remain between Medicare and Medicaid

Worked Examples

The following are illustrative, hypothetical examples. The plans are unnamed because extras, networks, and service areas vary by plan and year; confirm specifics with the plan or GeorgiaCares SHIP.

Example 1: Margaret, 70, QMB-Plus in a Coordination-Only D-SNP (Fulton County)

Margaret, age 70, lives in Atlanta. Her Social Security income is low enough to qualify for both QMB and full Medicaid (QMB-Plus). She has Type 2 diabetes, hypertension, and needs dentures.

She enrolls in a D-SNP offered in Fulton County during the fall enrollment window. The plan she picks includes:

• Dental benefit (covers her dentures)
• Vision benefit (annual exam plus eyewear)
• Hearing benefit (covers hearing aids)
• OTC allowance
• Rides to specialist appointments
• Post-discharge meals
• A gym membership
• Part D bundled (Extra Help sets her drug deductible at $0 and caps her copays)14

Her care coordinator helps coordinate her endocrinologist visits, schedules rides, and connects her to a local food program.

Her total out-of-pocket: near zero each month (no plan premium in this example, Medicaid pays her Medicare cost-sharing, and Extra Help holds drug costs to small copays).2

Example 2: James, 72, QMB-Only in a D-SNP That Accepts Partial-Benefit Duals (DeKalb County)

James, age 72, lives in Decatur. His Social Security income is low enough to qualify for QMB after the standard income disregard, but he does not have full Medicaid because his assets fall above the full-Medicaid limit while remaining below the MSP limit.

He checks that the plan he wants accepts QMB-only members, then enrolls. Its extras include:

• Dental
• Vision
• Hearing
• OTC allowance
• Transportation
• Post-discharge meals

His QMB status means Georgia Medicaid pays his Medicare premiums, deductibles, and coinsurance, so he owes nothing for Medicare-covered Part A and Part B services in network.13 His drugs are another matter: as a QMB-only enrollee with Extra Help, he pays up to $5.10 for a generic and $12.65 for a brand-name drug in 2026.2

His care coordinator helps him manage his COPD and refers him to a pulmonologist.

Example 3: Linda, 68, QMB-Plus in a D-SNP With a Rural Network (Worth County)

Linda, age 68, lives in rural Sylvester (Worth County). She has Social Security income that qualifies her for QMB-Plus. She has diabetes and needs regular dialysis.

She compares the D-SNPs offered in Worth County and picks the one whose network includes her dialysis center. Its extras include:

• Dental
• Vision
• Hearing
• OTC allowance
• Transportation (critical for dialysis several times a week)
• Post-discharge meals

Her care coordinator helps coordinate dialysis transportation, schedules nephrologist appointments, and refers her to Worth County DFCS for additional support.

Example 4: Sarah, 73, QMB-Plus, Coordinating a Hip Recovery (Hall County)

Sarah, age 73, lives in Gainesville. She qualifies for QMB-Plus and has been enrolled in a D-SNP for several years.

She falls and breaks her hip. After hospitalization and skilled nursing facility rehabilitation, her doctors recommend she transition to home with home health services and personal care services.

Her D-SNP care coordinator:

• Coordinates discharge planning with hospital
• Arranges Medicare-covered home health (covered by the D-SNP)
• Helps Sarah apply for Medicaid Community Care Services Program (CCSP) HCBS waiver for personal care
• Arranges post-discharge meals, which her plan offers as an extra
• Connects Sarah's daughter with the local Area Agency on Aging for caregiver support
• Schedules follow-up appointments with PCP and orthopedist

Total cost-sharing to Sarah: near zero (Medicaid pays cost-sharing, Extra Help holds drug costs to small copays, D-SNP includes enhanced benefits).

Weighing a D-SNP for Georgia Dual Eligibles

For many of Georgia's dual-eligible beneficiaries, a D-SNP consolidates Medicare and Medicaid into one plan with added benefits. What a D-SNP provides:

1. Coordinated care: care coordinators bridge Medicare and Medicaid
2. Possible extra benefits: dental, vision, hearing, transportation, and others, depending on the plan1
3. Low or zero out-of-pocket costs: Medicaid pays Medicare cost-sharing for QMB enrollees2
4. Bundled Part D: with LIS Extra Help zeroing the Part D deductible, zeroing the premium on a benchmark plan (you pay the difference on a plan priced above the regional benchmark), and holding copays to a few dollars per drug14
5. Some mid-year flexibility, with real limits: the once-monthly dual SEPs exist, but the Integrated Care SEP reaches only integrated plans, and Georgia is not on CMS's 2025 or 2026 list of states offering them, so for most Georgia D-SNP members the fall enrollment window still governs4

Every Georgia D-SNP works under a contract with the state that sets which dual eligibles it may enroll, where it operates, and how it coordinates your Medicaid benefits.3

While Georgia is not on CMS's 2025 or 2026 list of states offering FIDE-SNPs, the Coordination-Only D-SNPs available in Georgia can offer more coordination and added benefits than a standard MA plan or original Medicare alone for many dual eligibles.4 Whether a D-SNP is the right fit depends on your providers, your Medicaid category, and where you live.

If you or a family member is dually eligible for Medicare and Medicaid in Georgia, evaluating D-SNP options should be a priority. Free help is available from GeorgiaCares SHIP at 1-866-552-4464, option 4.5

For comprehensive help with D-SNPs and dual-eligible benefits in Georgia, these agencies can guide you:

Learn More

Find personalized help comparing Georgia D-SNPs and coordinating dual-eligible benefits at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.