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

Georgia has a sizable population of Medicare beneficiaries who are also eligible for Medicaid, a group known as dual eligibles. For them, Georgia's market of Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs) bundles Medicare coverage with care coordination that bridges Medicare and Medicaid. Dual eligibles are people who qualify for Medicare because of age (65+) or disability AND who have low enough income and assets to qualify for some form of Medicaid coverage in Georgia (full Medicaid for the lowest-income, or one of the Medicare Savings Programs (QMB, SLMB, QI) for slightly higher-income beneficiaries).

By Brevy Care Team · Last verified May 21, 2026

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
• 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 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.

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. 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.

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

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.)

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

The Enrollment Process

Special Enrollment Period (SEP) for Dual Eligibles

Dual eligibles have a unique Special Enrollment Period that allows them to:

• Enroll in a D-SNP at points during the year outside the Annual Enrollment Period
• Switch between D-SNPs through the integrated-care SEP
• Switch from a standard MA plan to a D-SNP
• Disenroll and return to original Medicare

This SEP makes D-SNP enrollment more flexible than enrollment in standard MA plans (which is generally limited to the Annual Enrollment Period Oct 15 to Dec 7).

Enrollment Frequency Limit

CMS limits the dual-eligible SEP to a set frequency per year (verify the current schedule at medicare.gov or with GeorgiaCares SHIP). The SEP does not apply between October 1 and December 31; the Annual Enrollment Period applies during that window.

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 (free unbiased counseling)
5. DFCS county office (some integration in process)

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 (federally capped at $9,250 in-network for 2026; most D-SNPs set the cap lower)

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. This typically means QMB D-SNP enrollees have $0 or near-$0 out-of-pocket costs for in-network care.

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).

Care Coordination Requirements

Federal Care Coordination Mandate

Under federal D-SNP regulations and the SMAC with Georgia DCH, D-SNPs must provide:

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
• 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.

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. Use the SEP: dual eligibles can switch plans during the year; don't wait for AEP if a better plan exists
5. Get free help from GeorgiaCares SHIP: call 1-866-552-4464 for unbiased counseling
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

A few more common questions:

What is a D-SNP? A Dual-Eligible Special Needs Plan is a Medicare Advantage plan designed exclusively for beneficiaries who are dually eligible for Medicare and Medicaid. D-SNPs coordinate Medicare and Medicaid benefits and often include enhanced extras like dental, vision, hearing, transportation, OTC, and meals.

What are the three D-SNP subtypes? Coordination-Only D-SNPs (most common in Georgia), Highly Integrated Dual-Eligible SNPs (HIDE-SNPs, limited in Georgia), and Fully Integrated Dual-Eligible SNPs (FIDE-SNPs, not available in Georgia).

Who are the top D-SNP carriers in Georgia? UnitedHealthcare Dual Complete, Humana Honor Choice, Aetna Dual Eligible, Anthem MediBlue, and WellCare Liberty (Centene).

Do I need medical underwriting to join a D-SNP? No. D-SNP enrollment is guaranteed for eligible dual eligibles regardless of health conditions.

What benefits do D-SNPs include? All standard Medicare Advantage benefits (Parts A, B, often D), plus enhanced extras: dental, vision, hearing, transportation, OTC, meals, fitness, and care coordination.

Will I have a care coordinator? Yes. Every D-SNP enrollee is assigned a care coordinator who helps navigate Medicare and Medicaid, coordinates appointments, identifies needs, and connects to community resources.

Can I keep my current doctors? Only if they are in the D-SNP's network. Check the D-SNP's provider directory before enrolling.

What if I see an out-of-network provider? Most D-SNPs are HMOs and do not cover out-of-network care except in emergencies. Some are PPOs and cover out-of-network at higher cost-sharing (but Medicaid may pay some of that for QMB).

How does Part D work in a D-SNP? Most D-SNPs include bundled Part D. The Low-Income Subsidy (automatic for MSP and full-Medicaid enrollees) reduces Part D premium, deductible, and copays substantially; check the current CMS LIS copay tables for the specific copay amounts that apply to your category.

What is the State Medicaid Agency Contract (SMAC)? A federally required contract between each D-SNP and the Georgia DCH (state Medicaid agency) specifying integration requirements, care coordination, member materials, and appeals processes.

What if I lose Medicaid eligibility? The D-SNP must provide a federally required grace period to restore Medicaid eligibility. If you cannot restore Medicaid, the D-SNP must disenroll you and help you transition to a non-SNP plan or original Medicare.

Can I switch from a D-SNP to original Medicare? Yes, during the available SEP windows for dual eligibles plus the Annual Enrollment Period.

Are D-SNPs the same as Medicare-Medicaid Plans (MMPs)? No. MMPs were the Financial Alignment Initiative demonstration plans for fully integrated dual eligibles. The FAI demonstration sunset on 12/31/2025, with enrollees transitioned to FIDE-SNPs, HIDE-SNPs, standard D-SNPs, or fee-for-service. Georgia did not participate in the MMP demonstration.

Are D-SNPs available in rural Georgia? Most D-SNPs are statewide and available in rural areas, though provider networks may be thinner. WellCare Liberty has a notable rural Georgia presence.

Will a D-SNP cover long-term care? D-SNPs cover Medicare-covered skilled nursing facility care (up to 100 days per benefit period). Medicaid covers long-term nursing facility care and HCBS waiver services through fee-for-service Medicaid in Georgia.

How do appeals work in a D-SNP? Federal regulations require integrated appeals processes for plans that meet the Applicable Integrated Plan threshold; the specifics combine Medicare and Medicaid appeals into a single process. Practical experience varies; ask for help from GeorgiaCares SHIP or Atlanta Legal Aid if appeals are complex.

Can I have a D-SNP and a Medigap policy? Generally no. Medigap supplements original Medicare, not Medicare Advantage. If you enroll in a D-SNP, you should drop Medigap (Medicaid pays your Medicare cost-sharing for QMB).

What is QMB-Plus? QMB-Plus is the combination of QMB (Medicare Savings Program) and full Medicaid eligibility. QMB-Plus beneficiaries have the most comprehensive coverage and benefit most from D-SNP enrollment.

Can I enroll in a D-SNP if I have only QMB and not full Medicaid? Yes. Most D-SNPs accept QMB-only enrollees, though benefit packages may differ.

How often do D-SNP benefits change? Annually. CMS approves D-SNP benefit packages each summer for the following plan year (January 1). Review during AEP (Oct 15 to Dec 7) before deciding to stay or switch.

What if I move out of the D-SNP's service area? You qualify for a Special Enrollment Period to switch to a D-SNP in your new area, switch to a standard MA plan, or return to original Medicare. Notify your D-SNP of address changes promptly.

Worked Examples

Example 1: Fulton 70 Margaret, QMB-Plus Enrolled in UnitedHealthcare Dual Complete

Margaret, age 70, lives in Atlanta. She has Social Security income below 100% FPL and qualifies 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: DeKalb 72 James, QMB-Only Enrolled in Humana Honor Choice

James, age 72, lives in Decatur. He has Social Security income just below 100% FPL after the $20 disregard. He has QMB but not full Medicaid (his assets are above the full-Medicaid limit but below the MSP limit).

He enrolls in Humana Honor Choice. Benefits include:

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

His QMB pays Medicare cost-sharing for in-network care, so he has $0 copays.

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

Example 3: Cobb 75 Robert, Full Medicaid plus Medicare in Anthem MediBlue

Robert, age 75, lives in Marietta. He is enrolled in Aged, Blind, Disabled Medicaid and Medicare. He has dementia and his wife Susan is his caregiver.

He enrolls in Anthem MediBlue D-SNP. Benefits include:

• Care coordinator (especially valuable for dementia coordination)
• Dental
• Vision
• Hearing
• OTC allowance
• Transportation
• Post-discharge meals
• Medication therapy management

The care coordinator helps Susan navigate Medicare and Medicaid services, refers Robert to memory care evaluation, and connects the family to caregiver support resources.

Example 4: Worth County 68 Linda, QMB-Plus in WellCare Liberty (Rural)

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 5: Bibb 71 David, Switched from MA to D-SNP After QMB Approval

David, age 71, lives in Macon. He was originally enrolled in a standard Humana MA-PD plan when he was paying for the Part B premium himself.

After his wife passed away, his income dropped sharply, and he applied for and was approved for QMB. Using the dual-eligible SEP, David switches from his standard MA plan to Humana Honor Choice D-SNP. He gains:

• Care coordinator (especially helpful as a recent widower)
• Enhanced dental
• Larger OTC allowance
• More transportation trips
• Bereavement support resources

Example 6: Hall 73 Sarah, D-SNP Care Coordinator Coordinated Dental and Medicaid LTSS

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).

Conclusion: The Optimal Medicare Advantage Choice for Georgia Dual Eligibles

D-SNPs are the optimal Medicare Advantage option for many of Georgia's dual-eligible beneficiaries. They provide:

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 making drugs essentially free for most full duals
5. Year-round enrollment flexibility: SEP windows allow plan changes outside the standard AEP

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 provide substantial value over standard MA plans or original Medicare alone for many dual eligibles.

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.

For comprehensive help with D-SNPs:

• Medicare 1-800-MEDICARE
• SSA 1-800-772-1213
• GeorgiaCares SHIP 1-866-552-4464 (free D-SNP counseling)
• Georgia SMP 1-866-552-4464 (Medicare fraud)
• Georgia DCH 1-866-211-0950 (Medicaid agency)
• Georgia DOI 1-800-656-2298
• Medicare Rights Center 1-800-333-4114
• UnitedHealthcare Dual Complete 1-800-721-0627
• Humana Honor Choice 1-800-457-4708
• Aetna Dual Eligible 1-855-335-1407
• Anthem MediBlue 1-833-848-8729
• WellCare Liberty 1-866-799-5318
• Atlanta Legal Aid 404-377-0701
• GA Legal Services 1-800-498-9469
• Eldercare Locator 1-800-677-1116
• 211 Georgia

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