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 folds Medicare and Medicaid coverage into one plan with a personal care coordinator, and for many dual eligibles it adds dental, vision, hearing, and transportation while Medicaid picks up your Medicare cost-sharing. This guide covers who qualifies, how the three D-SNP subtypes differ, when you can enroll, and which carriers offer D-SNPs across Georgia. 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
• Enhanced benefits often unavailable in standard MA plans (dental, vision, hearing, transportation, OTC, meals, fitness)
• Often $0 out-of-pocket costs for in-network care, because Georgia Medicaid pays Medicare cost-sharing for Qualified Medicare Beneficiaries2
• Integration with Medicaid for those services Medicaid covers but Medicare does not (long-term services and supports, transportation, and similar)
• A single ID card and integrated member materials

D-SNPs have grown rapidly since their creation under federal law. Georgia today has a substantial D-SNP market with multiple statewide carriers, representing a meaningful share of Georgia's dual eligibles enrolled in Medicare Advantage. The remaining dual eligibles either remain in original Medicare with Medicaid, enroll in standard (non-D-SNP) Medicare Advantage plans, or are not enrolled in MA at all.

This guide walks through every aspect of Georgia's D-SNP market: the federal statutory framework, the three D-SNP subtypes (Coordination-Only, HIDE-SNP, FIDE-SNP), the eligibility requirements, the enrollment process and special enrollment periods, the benefit structure, the care coordination requirements under the State Medicaid Agency Contract (SMAC), the Georgia D-SNP carriers and plans, and the practical decision framework for whether a dual eligible should enroll in a D-SNP.

The Federal Statutory and Regulatory Framework

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

D-SNPs are a creature of federal law. Section 1859 of the Social Security Act authorizes Medicare Advantage Special Needs Plans (SNPs), and Section 1859(b)(6) specifically defines the Dual-Eligible Special Needs Plan as a SNP that:

"enrolls special needs individuals who are entitled to medical assistance under a State plan under Title XIX"

This statutory authority traces to the federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (the Medicare Modernization Act), which created the modern Medicare Advantage program and the three SNP types: D-SNP (dual eligibles), C-SNP (chronic conditions), and I-SNP (institutionalized).

Section 1859(f), State Medicaid Agency Contract (SMAC)

Section 1859(f) of the Social Security Act requires that every D-SNP have a contract with the State Medicaid Agency in each state where the D-SNP operates. This contract, called the State Medicaid Agency Contract (SMAC), is the key integration mechanism between the D-SNP's Medicare benefits and the state's Medicaid program.

The SMAC must specify:

1. The categories of dual eligibles the D-SNP will enroll
2. The Medicaid benefits the D-SNP will provide or coordinate
3. Cost-sharing protections for dually eligible enrollees
4. Care coordination requirements
5. Member materials integration
6. Data sharing between the D-SNP and the state Medicaid agency
7. Appeals and grievances coordination

In Georgia, the State Medicaid Agency Contract is administered by the Georgia Department of Community Health (DCH), which is the single state Medicaid agency. DCH must approve any D-SNP that operates in Georgia, and the SMAC must comply with both federal requirements and Georgia state Medicaid policy.

Federal D-SNP regulations under 42 CFR Part 422

The implementing regulations for D-SNPs sit in 42 CFR Part 422, including 42 CFR 422.2 (definitions) and 42 CFR 422.107 (SMAC requirements). CMS has revised these provisions over time to implement subsequent statutory changes to D-SNP integration.2

Bipartisan Budget Act of 2018 D-SNP integration

The Bipartisan Budget Act of 2018 made several important changes to D-SNPs:

1. Permanent authorization: D-SNPs are now permanently authorized (previously required periodic reauthorization)
2. Integration requirements: D-SNPs must meet integration standards, including:
   • Integrated member materials (single welcome packet, single ID card, integrated formulary)
   • Unified appeals and grievances processes (a single appeals route covering both Medicare and Medicaid services for plans subject to the Applicable Integrated Plan rules)
   • Care coordination requirements
3. D-SNP subtype definitions: The statute codified the three D-SNP subtypes (Coordination-Only, HIDE-SNP, FIDE-SNP)
4. State default enrollment: The statute authorized states to default-enroll Medicaid managed care enrollees who become Medicare-eligible into the D-SNP affiliated with their Medicaid plan (Georgia has not implemented default enrollment)

MMA, MIPPA, and the build-out of D-SNPs

The federal Medicare Modernization Act created the Medicare Advantage Special Needs Plan category, including D-SNPs. Before that, dual eligibles could only enroll in standard Medicare Advantage plans (which did not have to coordinate with Medicaid) or remain in original Medicare. The Medicare Improvements for Patients and Providers Act subsequently strengthened D-SNPs by requiring SMACs, requiring care coordination, establishing data-sharing requirements, and improving appeals and grievances coordination.

The Three D-SNP Subtypes

Subtype 1: Coordination-Only D-SNPs (C-D-SNPs)

The most common D-SNP subtype, Coordination-Only D-SNPs provide Medicare Advantage benefits with a care coordinator who helps the enrollee navigate Medicaid, but the Medicare and Medicaid programs remain separate.

Characteristics:

• D-SNP provides all Medicare benefits (Parts A, B, often D)
• Care coordinator assigned to each enrollee
• Care coordinator helps with Medicaid issues but does NOT directly administer Medicaid benefits
• Enrollee retains separate Medicaid coverage through fee-for-service Medicaid or a separate Medicaid managed care plan
• Medicaid pays Medicare cost-sharing for QMB beneficiaries through fee-for-service Medicaid

Most common in Georgia: The major Georgia D-SNPs (UnitedHealthcare Dual Complete, Humana Honor Choice, Aetna Dual Eligible, Anthem MediBlue, WellCare Liberty) operate as Coordination-Only D-SNPs because Georgia does not have Medicaid managed long-term services and supports (Medicaid MLTSS).

Advantages:

• Wide carrier choice
• Available in most Georgia counties
• Some integration via care coordination
• Lower implementation complexity

Disadvantages:

• Less integration than HIDE-SNP or FIDE-SNP
• Member must still navigate two separate insurance programs to some degree
• Care coordinator can advocate but not directly approve Medicaid services

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

HIDE-SNPs combine a D-SNP with an affiliated Medicaid managed care plan, where both plans are operated by the same parent organization (for example, the D-SNP and the Medicaid MCO are both operated by UnitedHealthcare). This provides a higher level of integration.

Characteristics:

• D-SNP and Medicaid MCO have same parent organization
• Single care coordinator manages both Medicare and Medicaid benefits
• Some integrated member materials
• Same provider network for some services
• Coordinated appeals (though still separate Medicare and Medicaid appeals routes)

In Georgia: Limited availability. Some HIDE-SNPs exist where a carrier operates both a Medicaid managed care plan and a D-SNP. However, Georgia's Medicaid managed care is limited and does not extensively cover the dual-eligible population, limiting HIDE-SNP availability.

Advantages:

• Higher integration than C-D-SNP
• Single care coordinator
• Familiar provider network
• Some unified processes

Disadvantages:

• Still separate Medicare and Medicaid plans technically
• Limited availability in Georgia
• Requires enrollee to also enroll in the affiliated Medicaid managed care plan

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

FIDE-SNPs combine D-SNP and Medicaid managed care into a single integrated plan that delivers all Medicare and Medicaid benefits through a single contract, single ID card, single appeals process, and single care coordinator.

Characteristics:

• Single integrated plan for all Medicare and Medicaid benefits
• Includes Medicaid long-term services and supports (LTSS)
• Single ID card
• Single appeals/grievances process
• Single care coordinator
• Highest level of integration

In Georgia: No FIDE-SNPs operate in Georgia. Under 42 CFR 422.2, a FIDE-SNP delivers Medicaid long-term services and supports through a capitated Medicaid managed care contract; Georgia has not contracted Medicaid managed long-term services and supports (Medicaid MLTSS), which is a prerequisite for FIDE-SNP authorization. Other states have FIDE-SNPs, but Georgia does not.2

Advantages:

• Complete integration
• Easiest member experience
• Single care coordinator manages everything
• Strong evidence of better health outcomes and lower costs

Disadvantages:

• Not available in Georgia (and many other states)
• Limited carrier choice in states where available
• Requires strong state Medicaid program design

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.)2

Medicaid Eligibility

D-SNP enrollees must have one of the following Medicaid eligibility categories:

1. Full-benefit Medicaid (Full Dual): beneficiary qualifies for all Medicaid benefits including long-term care, transportation, dental, etc.
2. QMB-Plus: Qualified Medicare Beneficiary with full Medicaid (combination)
3. QMB-Only: Qualified Medicare Beneficiary with Medicare cost-sharing assistance but not full Medicaid
4. SLMB-Plus: Specified Low-Income Medicare Beneficiary with full Medicaid (combination)
5. SLMB-Only: Specified Low-Income Medicare Beneficiary with only Part B premium assistance
6. QI: Qualifying Individual with only Part B premium assistance
7. QDWI: Qualified Disabled and Working Individual (rare; some D-SNPs accept QDWI)

The specific Medicaid categories accepted by each D-SNP are specified in the plan's SMAC with Georgia DCH. Some D-SNPs only accept full-benefit Medicaid (FBDE); others accept any dual eligibility category.

Residency

D-SNP enrollees must reside in the D-SNP's service area within Georgia. Service areas vary by plan:

• Some D-SNPs are statewide
• Others are limited to specific regions (for example, Atlanta metro only)
• A few are county-specific

Enrollment Verification

D-SNPs verify Medicaid eligibility regularly through the Georgia DCH data exchange. If an enrollee loses Medicaid eligibility, the D-SNP must:

1. Provide a federally required grace period during which the enrollee can attempt to restore Medicaid eligibility (consult your plan and the latest CMS D-SNP guidance for the current grace-period duration)
2. Notify the enrollee
3. Help the enrollee restore Medicaid eligibility if possible
4. Disenroll the enrollee if Medicaid eligibility cannot be restored

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.1

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.1

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 are in Medicaid fee-for-service or in a Medicaid managed care plan that is not affiliated with the D-SNP, you cannot use it.1

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. Georgia's D-SNPs are overwhelmingly coordination-only, and a coordination-only D-SNP is not an integrated plan, so it cannot be reached through the Integrated Care SEP. 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.1

No Underwriting

D-SNP enrollment never requires medical underwriting. Dual eligibles are guaranteed acceptance regardless of health conditions.

Auto-Assignment for QMB-Plus

Some states automatically assign QMB-Plus beneficiaries to a D-SNP affiliated with their Medicaid managed care plan. Georgia does NOT currently use auto-assignment; beneficiaries must actively choose to enroll in a D-SNP.

Enrollment Methods

Beneficiaries can enroll in a D-SNP through:

1. Direct enrollment with the carrier (most common)
2. Medicare Plan Finder at medicare.gov
3. Insurance broker or agent
4. GeorgiaCares SHIP at 1-866-552-4464, option 4 (free unbiased counseling)3
5. Georgia Division of Family and Children Services (DFCS) county office (some integration in process)

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, the D-SNP applies a grace period during which you can restore eligibility and stay enrolled; if you cannot restore it, the plan moves you to a similar non-SNP plan from the same insurer or returns you to original Medicare (the disenrollment steps are laid out under Enrollment Verification above).

One coordination trap is worth planning for before it happens. A D-SNP cannot be paired with a Medigap policy, because Medigap supplements original Medicare, not Medicare Advantage, and a D-SNP is a Medicare Advantage plan. 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 does not add an annual "birthday rule" or any other yearly state guaranteed-issue window for switching plans. Once that six-month window closes, an insurer may use medical underwriting and can decline you or charge more based on health, except where a federal guaranteed-issue right applies. So a dual eligible who later leaves a D-SNP for original Medicare, whether by choice or because Medicaid lapsed, can face underwriting if they then want a Medigap policy. 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 under-65 premiums are commonly much higher and the scope of the right varies, so confirm the specific plan letters with GeorgiaCares. While you hold QMB or full Medicaid the point is largely moot, since Medicaid pays your Medicare cost-sharing; the risk appears only if that protection ends.4

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) in most D-SNPs
• 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)5

Medicare Cost-Sharing Payment for QMB

For QMB beneficiaries enrolled in a D-SNP, Georgia Medicaid pays the Medicare cost-sharing (deductibles, coinsurance, copayments) up to the Medicaid rate. 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

Enhanced Benefits Often Included in D-SNPs

D-SNPs typically include enhanced benefits not standard in original Medicare:

• Dental: preventive cleanings, exams, restorative work (varies by plan)
• Vision: annual exams plus eyewear allowance
• Hearing: annual exams plus hearing aids
• Over-the-counter (OTC): quarterly OTC allowance
• Transportation: non-emergency medical transportation (NEMT); some plans offer dental, grocery, or pharmacy transportation
• Meals: post-discharge meal delivery
• Fitness: SilverSneakers or equivalent gym membership
• Wellness: annual wellness visits, preventive care
• Care coordination: assigned care coordinator
• Medicare Part D: bundled prescription drug coverage with Low-Income Subsidy (Extra Help) cost-sharing

Medicaid Wrap

D-SNP enrollees retain their Medicaid coverage for services Medicaid covers but Medicare does not, including:

• Long-term services and supports (LTSS): nursing facility care, home and community-based services (HCBS) waivers
• Some dental and vision (in addition to D-SNP benefits)
• Transportation
• Personal care services
• Adult day care (in some waivers)

In Georgia, Medicaid covers long-term care through fee-for-service Medicaid (the state has not contracted MLTSS managed care).

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.6 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 with 30 to 39 quarters, or $565 per month with fewer than 30 quarters, in 2026. 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.5

On the drug side, anyone with Medicaid automatically qualifies for full Extra Help (the Part D Low-Income Subsidy), with no separate application. Under full Extra Help in 2026, an enrollee pays no more than $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 catastrophic threshold. The former partial-subsidy tier was eliminated in 2024, so everyone who qualifies now receives the full subsidy.6

Georgia's D-SNP readers usually sit in an even cheaper tier than that. If you have full Medicaid coverage and are in the QMB program, you pay no more than $4.90 for each covered drug in 2026. It is a small number, but it is 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

Federal Care Coordination Mandate

Under federal D-SNP regulations and the SMAC with Georgia DCH, D-SNPs must provide the following, with integrated D-SNPs treated as "applicable integrated plans" that combine Medicare and Medicaid grievances and appeals:2

1. Care coordinator assignment: each enrollee assigned a care coordinator
2. Initial health risk assessment: completed within the federally required timeframe after enrollment
3. Care plan development: individualized care plan based on health risk assessment
4. Care plan updates: annually and as needed
5. Interdisciplinary care team: coordination of multiple providers
6. Member engagement: outreach and education
7. Medicaid coordination: coordination with Medicaid providers and services

Care Coordinator Functions

A D-SNP care coordinator typically:

• Reviews medical and pharmacy claims
• Coordinates appointments with PCPs and specialists
• Helps navigate Medicaid services
• Coordinates with hospital discharge planners
• Helps obtain durable medical equipment (DME)
• Identifies and addresses social determinants of health (housing, food, transportation)
• Refers to community-based services
• Helps with appeals and grievances

Integration with Medicaid

While the care coordinator is employed by the D-SNP (not Medicaid), the SMAC requires the D-SNP to coordinate with Georgia Medicaid for:

• Long-term care assessments
• HCBS waiver enrollment, including the Community Care Services Program (CCSP) and SOURCE
• Home health services
• Personal care services
• Nursing facility transitions

Georgia D-SNP Carriers and Plans

UnitedHealthcare Dual Complete

• One of the largest D-SNP carriers in Georgia
• Statewide availability
• Strong Atlanta metro network
• Generous dental allowance
• Vision and hearing benefits
• OTC allowance
• Non-emergency medical transportation
• Post-discharge meals
• SilverSneakers

Humana Honor Choice

• Statewide availability
• Strong provider network
• Generous dental allowance
• Vision and hearing benefits
• OTC allowance
• Non-emergency medical transportation
• Post-discharge meals
• Gym membership

Aetna Dual Eligible

• Statewide availability
• Dental allowance
• Vision and hearing benefits
• OTC allowance
• Non-emergency medical transportation
• Post-discharge meals

Anthem MediBlue

• Statewide availability through Blue Cross Blue Shield GA
• Strong provider network statewide
• Dental allowance
• Vision and hearing benefits
• OTC allowance

WellCare Liberty (Centene)

• Statewide availability
• Often lowest cost-sharing
• Dental allowance
• Vision and hearing benefits
• OTC allowance
• Strong rural Georgia presence

Other Carriers

Smaller D-SNP options may include Kaiser Permanente (Atlanta only), some regional carriers, and CMS-approved emerging plans. Plan availability changes annually; check medicare.gov Plan Finder during each AEP for current carrier and benefit details.

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

Rarely, but 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, and Medicaid will pay Medicare cost-sharing through fee-for-service Medicaid.

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 4.3

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) before enrolling
4. Know which SEP you actually have: the once-monthly Integrated Care SEP reaches only integrated plans, and Georgia's D-SNPs are mostly coordination-only, so confirm before assuming a mid-year switch is available
5. Get free help from GeorgiaCares SHIP: call 1-866-552-4464, option 4, for unbiased counseling3
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: D-SNP care coordinator can help connect to Medicaid LTSS but cannot directly enroll
13. Report provider balance billing: providers cannot balance bill QMB enrollees in D-SNPs
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. PCP requirement: most D-SNPs require PCP designation; choose carefully
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. Limited HIDE-SNP availability: Georgia has few HIDE-SNPs and no FIDE-SNPs
8. Out-of-area coverage: D-SNPs typically only cover emergencies out-of-area
9. Annual plan changes: benefits and provider networks change each year
10. Confusion with Medicaid managed care: Georgia's Medicaid managed care is limited and separate from D-SNP
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: non-emergency medical transportation typically requires advance booking
14. Coordination gaps: even with care coordinator, some gaps remain between Medicare and Medicaid

Worked Examples

The following are illustrative, hypothetical examples. Benefit details vary by plan and year; confirm specifics with the plan or GeorgiaCares SHIP.

Example 1: Margaret, 70, QMB-Plus in UnitedHealthcare Dual Complete (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 UnitedHealthcare Dual Complete during her Initial Enrollment Period. The D-SNP includes:

• Dental benefit (covers her dentures)
• Vision benefit (annual exam plus eyewear)
• Hearing benefit (covers hearing aids)
• OTC allowance
• Transportation trips (to dialysis, specialist appointments)
• Post-discharge meals
• SilverSneakers gym
• Part D bundled (LIS Extra Help covers most drug copays)

Her care coordinator helps coordinate Emory endocrinologist visits, schedules transportation, and connects her to Atlanta Community Food Bank.

Her total out-of-pocket: near zero each month (no MA premium, Medicaid pays cost-sharing, LIS covers most Part D costs).

Example 2: James, 72, QMB-Only in Humana Honor Choice (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 enrolls in Humana Honor Choice. Benefits include:

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

His QMB status means Georgia Medicaid pays his Medicare cost-sharing for in-network care, so he pays nothing out of pocket for covered in-network services.

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

Example 3: Linda, 68, QMB-Plus in WellCare Liberty (Rural 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 enrolls in WellCare Liberty D-SNP, which has strong rural Georgia provider networks. Benefits 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 in Aetna Dual Eligible, Coordinating a Hip Recovery (Hall County)

Sarah, age 73, lives in Gainesville. She qualifies for QMB-Plus and has been enrolled in Aetna Dual Eligible 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
• Schedules dental work needed before hospital readmission (covered under the D-SNP dental benefit)
• Arranges post-discharge meals
• Coordinates with the Gainesville Area Agency on Aging for caregiver support for Sarah's daughter
• Schedules follow-up appointments with PCP and orthopedist

Total cost-sharing to Sarah: near zero (Medicaid pays cost-sharing, LIS covers most Part D drugs, 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. Enhanced benefits: dental, vision, hearing, transportation, OTC, meals, fitness
3. Low or zero out-of-pocket costs: Medicaid pays Medicare cost-sharing for QMB enrollees
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 drug6
5. Some mid-year flexibility, with real limits: the once-monthly dual SEPs exist, but the Integrated Care SEP reaches only integrated plans, so for Georgia's mostly coordination-only D-SNPs the fall enrollment window still governs1

Georgia's D-SNP market is mature and competitive, with multiple plans and five major carriers (UnitedHealthcare, Humana, Aetna, Anthem, WellCare/Centene). The federal framework under Section 1859 of the Social Security Act and 42 CFR Part 422 requires integration with Georgia Medicaid through the SMAC.

While Georgia does not yet have FIDE-SNPs (which require Medicaid MLTSS), 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. 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 4.3

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.