How a D-SNP works
A D-SNP is a type of Medicare Advantage plan. Like other Medicare Advantage plans, it covers Part A and Part B services and usually Part D drugs, with its own network and rules. Unlike others, it may enroll only people who have Medicare and Medicaid. Federal rules require each D-SNP to have a contract with the state Medicaid agency (42 CFR 422.107).
Medicare Advantage plans may offer extra benefits such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
D-SNPs in North Carolina for 2027
- Coordination-only. CMS's CY2027 Landscape data lists every North Carolina D-SNP as "coordination only." None is a fully integrated (FIDE) or highly integrated (HIDE) plan, so no D-SNP in the state also delivers your Medicaid benefits.
- Available statewide. CMS data shows 26 D-SNP plans in North Carolina for 2027, offered in all 100 counties; the number varies by county. They are part of the 57 special needs plans in the state.
- Your Medicaid stays in NC Medicaid Direct. NC Medicaid lists people who get Medicaid and Medicare under NC Medicaid Direct, so joining a D-SNP doesn't move you into a Medicaid health plan.
- PACE is the integrated option. For people 55 and older who need a nursing-home level of care, PACE combines Medicare and Medicaid care through one organization.
When you can join or switch
- Open Enrollment, October 15 – December 7. Changes take effect January 1.
- Medicare Advantage Open Enrollment, January 1 – March 31. If you are in a Medicare Advantage plan, you can switch plans or go to Original Medicare once.
- Monthly, to Original Medicare and a Part D plan. People with Medicaid or Extra Help can make this change once a month (42 CFR 423.38(c)(4)).
- When your plan ends. If your plan is leaving for 2027, see plans ending in 2027.
Questions to ask before choosing
- Which Medicaid groups does the plan accept? Confirm your Medicaid category qualifies.
- Are my doctors and pharmacies in its network? Check each one with the plan.
- Are my drugs on its formulary? Compare with your current coverage.
To compare D-SNPs and other plans from the companies they work with, you can request a call from a licensed insurance agent. More: D-SNPs in North Carolina and D-SNP vs. Original Medicare and NC Medicaid.
Related questions
Are dual eligibles in NC Medicaid managed care?
Why most stay in NC Medicaid Direct.
Can I have NC Medicaid and Medicare at the same time?
How dual eligibility works.
Medicare vs. Medicaid in North Carolina
The two programs side by side.
Sources
- Medicare.gov — Special Needs Plans (SNP)
- CMS — CY2027 Landscape files (D-SNP integration status, North Carolina)
- eCFR — 42 CFR 422.107, D-SNP contracts with the state Medicaid agency
- eCFR — 42 CFR 423.38, Part D enrollment periods
- NC Medicaid — Medicaid Health Plans and Programs
- NC Medicaid — PACE
More questions in this guide
- Are people with Medicare and Medicaid in NC Medicaid managed care?
- Can I have NC Medicaid and Medicare at the same time?
- Did NC Medicaid expansion change anything for people on Medicare?
- Does NC Medicaid pay for nursing home care?
- Does NC Medicaid take your house after you die?
- Medicare vs. Medicaid in North Carolina
- What is Special Assistance in North Carolina?
- What is the CAP/DA waiver in North Carolina?
- What is the Medicaid look-back period in North Carolina?
Part of the guide: NC Medicaid and Medicare together · All questions
Frequently asked questions
Do I need full Medicaid to join a D-SNP in North Carolina?
It depends on the plan. Every D-SNP is limited to people with Medicare and some level of Medicaid, but each plan sets which Medicaid groups it accepts, such as full Medicaid or MQB. Check the plan's eligibility rules before you enroll.
Can I change D-SNPs every month in North Carolina?
No. The monthly special enrollment period for full dual eligibles applies only to fully integrated, highly integrated or applicable integrated plans (42 CFR 423.38(c)(35)), and North Carolina has none for 2027. You can switch to Original Medicare with a stand-alone Part D plan once a month (42 CFR 423.38(c)(4)).
Does a D-SNP replace my NC Medicaid?
No. A D-SNP replaces Original Medicare, not Medicaid. Your NC Medicaid stays in NC Medicaid Direct, and Medicaid continues to pay after the plan for what it covers.
Medicare in your North Carolina county
Plans, local agents and help, county by county: Wake · Mecklenburg · Guilford · Forsyth · Durham · Cumberland · Buncombe · Union · Johnston · Cabarrus · New Hanover · Gaston · Onslow · Iredell · Alamance · Pitt · Davidson · Brunswick · Catawba · Rowan · All 100 counties →
