Wisconsin D-SNP Plans 2026: Family Care Partnership and Your Options

If you're in Family Care Partnership or a Supplemental Security Income (SSI) Medicaid HMO in Wisconsin, your Medicare may start in that same company's D-SNP unless you opt out.1 Wisconsin's default enrollment covers SSI HMO and Partnership members getting Medicare for the first time with full Medicaid, and the D-SNP (dual eligible special needs plan) sends a notice and opt-out form 60 days before Medicare starts.1 Partnership D-SNPs are also Wisconsin's only fully integrated D-SNPs, known as FIDE SNPs, and you can join one only if you're already in Family Care Partnership, a Medicaid long-term care program that requires a nursing home level of care.2 For every other Wisconsin D-SNP, the Wisconsin Department of Health Services (DHS) says the plan works best when the same company also runs your Medicaid HMO.3

In This Guide

• Wisconsin's D-SNP Options Side by Side
• Family Care Partnership D-SNPs: Who Can Join
• Other Wisconsin D-SNPs and Your Medicaid HMO
• Got a Default Enrollment Letter? What to Do
• Changing Plans Later
• If You Lose Medicaid While in a D-SNP
• What Changes in 2027
• Free Help With Wisconsin D-SNPs
• Frequently Asked Questions
• Learn More

Wisconsin's D-SNP Options Side by Side

A dual eligible special needs plan (D-SNP) is a Medicare Advantage plan for people who have both Medicare and Medicaid. Federal rules define more integrated D-SNP tiers, and the most integrated is the FIDE SNP, in which one company holds both the Medicare Advantage contract and the Medicaid managed care contract.5,6 The Centers for Medicare & Medicaid Services (CMS) lists Wisconsin among the states with all three types of D-SNP in 2026: FIDE SNPs, highly integrated (HIDE) SNPs and coordination-only D-SNPs.2

In its September 2026 guidance for counselors, DHS counts 13 D-SNPs in Wisconsin: three are Family Care Partnership D-SNPs (FIDE SNPs), and ten have aligned SSI Medicaid HMOs.1,3

Source: Wisconsin DHS.

Nationally, fully integrated plans are rare: the Medicare Payment Advisory Commission (MedPAC) found that in 2024 only 3 percent of all people with both Medicare and Medicaid were enrolled in a FIDE SNP.6

Family Care Partnership D-SNPs: Who Can Join

Family Care Partnership is a Wisconsin Medicaid program, offered alongside Family Care and the Program of All-Inclusive Care for the Elderly (PACE), for older adults and adults with disabilities who need long-term care.7 Under Wisconsin's 2026 Partnership D-SNP contract, Partnership eligibility requires all of the following:2

• Being in the frail elder, physical disability or developmental disability target group.
• Living in a county where Family Care Partnership is offered.
• Eligibility for a full-benefit Medicaid program.
• A nursing home level of care on the Long-Term Care Functional Screen.
• Age 18 or older.

To join a Partnership D-SNP, you must have full Medicaid and be enrolled in Family Care Partnership with that plan's organization, and the 2026 contract limits each plan to people living in a Wisconsin county where it's offered. DHS also says dually eligible Partnership members are required to enroll in their managed care organization's D-SNP.2 Our guide to Wisconsin Medicaid HCBS waivers covers how to apply for Family Care, Partnership and IRIS. DHS tells people who need long-term care to start with their local aging and disability resource center (ADRC).7

Which companies run Partnership D-SNPs

DHS names the three Partnership organizations as Community Care Health Plan, Independent (iCare) Health Plan and My Choice Wisconsin Health Plan (whose parent DHS lists as Care Wisconsin/MyChoice Wisconsin), and its managed care contact list gives each one its own Partnership counties.1 Your ADRC can tell you which of them serve your county.

What fully integrated means for a Partnership member

DHS says the Partnership plan is responsible for coordinating all the services in a Partnership D-SNP member's plan of care, and coordinating Medicare and Medicaid benefits is not the member's responsibility.1

Appeals work differently too. Family Care Partnership FIDE SNP members file one unified appeal or grievance whether the problem involves Medicare or Medicaid, and only the three Partnership plans have that unified process in Wisconsin. Members of every other Wisconsin D-SNP follow the separate Medicare and Medicaid appeal and grievance processes.1

Other Wisconsin D-SNPs and Your Medicaid HMO

Outside Partnership, DHS says Medicare and Medicaid usually don't coordinate when they come from the government or from different companies, and that D-SNPs work best when you're enrolled in the same company's Medicaid HMO or managed care organization.3

Which Wisconsin D-SNP you can join depends on how you get your Medicaid. DHS's guidance for SHIP counselors spells out the rules:3

• Fee-for-service Medicaid: a dual eligible with Medicare and full Medicaid can join any D-SNP that accepts people with full-benefit Medicaid.
• A Medicaid managed care plan: you can join only a D-SNP offered by the same parent organization as your managed care plan.
• SSI Medicaid HMOs are optional for dual eligibles: people with both Medicare and Medicaid aren't required to join an SSI HMO and can choose fee-for-service Medicaid instead.
• Family Care or IRIS: participants may join a D-SNP, but the D-SNP company can't manage or coordinate their long-term care benefits.

What you'll pay in a Wisconsin D-SNP

DHS describes a D-SNP as one plan for your hospital, medical and prescription costs, with little or no cost to you, and says that in some plans, people with full Medicaid or the Qualified Medicare Beneficiary (QMB) program pay less than people with other types of Medicaid.3 For a specific plan's premium and copays, check its Summary of Benefits or ask SHIP.

QMB carries the firmest protection. Federal law bars Medicare providers, including Medicare Advantage providers such as those in a D-SNP network, from billing a person in the QMB group for Medicare Part A and Part B deductibles, coinsurance and copays; CMS notes a small Medicaid copayment may still apply in some cases.5 In Wisconsin, QMB also pays Part A and Part B premiums, and DHS automatically enrolls people receiving SSI in QMB.8

If you have Medicare plus only a Medicare Savings Program, you're a partial-benefit dual eligible rather than a full-benefit one.5 Our guide to Wisconsin Medicare Savings Programs covers the 2026 income and asset limits for QMB and the other savings programs.

How to enroll in a Wisconsin D-SNP

DHS lists three ways to enroll: call the plan you want to join, use Medicare.gov, or call Medicare at 800-633-4227. Not every plan is available in every region, and you may be able to enroll only at certain times of the year.3

Got a Default Enrollment Letter? What to Do

Wisconsin's D-SNP default enrollment applies to a member of an SSI Medicaid HMO or a Family Care Partnership plan who becomes eligible for Medicare for the first time as a full-benefit dual eligible, and it moves that person into a D-SNP run by the same company.1 Default enrollment happens only where the person lives in a county in which that company runs a D-SNP with at least 80% overlap between its provider networks, and D-SNP companies aren't required to do it.1

For an SSI Medicaid HMO member, saying no keeps Medicaid as it is. DHS's notice template tells SSI HMO members they don't have to join, and that if they don't want to be automatically enrolled, or choose Original Medicare or another Medicare health plan, "your Medicaid coverage will not change."1

If you were default-enrolled and want out later, a Special Enrollment Period allows a one-time change within three months of the notice or the effective date, whichever is later. DHS sums it up as a chance to change to a different plan within 90 days after Medicare starts.1

Which companies send default enrollment letters

DHS's D-SNP page lists four companies that conduct default enrollment in Wisconsin.3

Companies may start default enrollment on a rolling basis as they're approved, so this list can grow.3 Partnership organizations can also default-enroll their own members when they first get Medicare.1

Changing Plans Later

Two monthly federal Special Enrollment Periods matter for full-benefit dual eligibles. Since 2025, a monthly integrated care Special Enrollment Period lets a full-benefit dual eligible enroll in an aligned FIDE, HIDE or applicable integrated D-SNP. A separate monthly Special Enrollment Period lets dual eligibles and people with Extra Help pick a standalone Part D drug plan in any month.9 Our guide to Medicare special enrollment periods covers the other change windows.

If You Lose Medicaid While in a D-SNP

A D-SNP depends on your Medicaid. Under federal rules, when a special needs plan expects a member who lost Medicaid to requalify within six months, the plan treats that person as still eligible for a period it chooses, anywhere from one to six months. The plan should send a disenrollment notice at least 30 days before ending coverage.10 Ask your plan how long its period is, and call SHIP as soon as you learn your Medicaid may end.

What Changes in 2027

Under a federal rule, a D-SNP whose company also runs a Medicaid managed care plan for full-benefit dual eligibles in the same area must, from 2027, limit new enrollment to people in, or enrolling in, that company's Medicaid plan; from 2030 it may only enroll or keep those members. Existing members who aren't aligned can stay in their D-SNP until 2030.11

The rule has an exception for Medicaid fee-for-service: where a state doesn't require Medicaid managed care for all full-benefit dual eligibles and the state contract allows it, a company may enroll full-benefit dual eligibles who are in fee-for-service Medicaid in a coordination-only or HIDE D-SNP.11 Partnership D-SNPs are already exclusively aligned: Wisconsin's 2026 contract requires each one to maintain exclusively aligned enrollment for the whole contract period.2 Wisconsin is also one of 23 states and territories whose integrated D-SNPs use the joint CMS and state model member materials, such as the member handbook and ID card, for contract year 2027.12 If you're in another Wisconsin D-SNP, ask SHIP whether the 2027 limits apply to your plan.

Free Help With Wisconsin D-SNPs

Wisconsin SHIP offers free, unbiased Medicare counseling, and DHS says its counselors don't sell anything and aren't paid by a company or plan.4 You can reach SHIP through the Wisconsin Medigap Helpline at 800-242-1060, or call the Wisconsin Medigap Part D and Prescription Drug Helpline at 855-677-2783 with drug plan questions.4 Our Wisconsin SHIP guide explains how to find a local benefit specialist.

Learn More

Find personalized help choosing a Wisconsin dual eligible plan 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.