Reviewed by Russell Noga, Licensed Medicare Insurance Broker (all 50 states) — Last updated October 8, 2026
Medicare dual plans are Dual Special Needs Plans (D-SNPs) for people with both Medicare and Medicaid; they coordinate both programs and may include low costs and extra benefits.
For 2027, Special Needs Plans are growing, and some insurers will offer only SNPs. Availability depends on your state and Medicaid level.
✔ Licensed in all 50 states
✔ Based on CMS 2027 data
✔ Free plan comparison
For Medicare + Medicaid.
Coordinates both programs.
May include low costs.
SNPs growing for 2027.
Special Needs Plans (SNPs) are Medicare Advantage plans built for specific groups. Benefits, networks and drug lists are designed around the members they serve, and many include care coordinators. For 2027, Special Needs Plans are one of the few areas where large insurers are adding plans, even as they cut PPOs.
| Type | Who Qualifies | What Is Different |
|---|---|---|
| Dual Special Needs Plan (D-SNP) | People with both Medicare and Medicaid | Coordinates both programs; often very low costs and added benefits |
| Chronic Condition SNP (C-SNP) | People with qualifying conditions such as diabetes, heart failure or chronic lung disease | Doctors, drugs and programs built around the condition |
| Institutional SNP (I-SNP) | People living in a nursing home or who need that level of care at home | Care delivered where the member lives |
May Include
Low or $0 copays
Drug coverage with Extra Help
Dental, vision, hearing
OTC allowances
Care coordination
Not all plans offer all benefits.
If your income and savings are limited, two programs can cut your Medicare costs sharply:
Medicare Savings Programs
Run by your state Medicaid office
Can pay your Part B premium, and sometimes deductibles and coinsurance
Income and asset limits vary by state
Extra Help (Part D)
Run by Social Security
Lowers Part D premiums, deductibles and copays
People in a Medicare Savings Program qualify automatically
Those who are eligible for Medicare along with full Medicaid might also have the option of enrolling in a Dual Special Needs Plan. Learn more about help for low-income Part D beneficiaries.
| Enrollment Period | Dates | What You Can Do |
|---|---|---|
| Annual Enrollment Period | October 15 to December 7, 2026 | Join, switch or drop a Medicare Advantage or Part D plan for January 1, 2027 |
| Medicare Advantage Open Enrollment | January 1 to March 31, 2027 | If you are in Medicare Advantage, switch to another plan or return to Original Medicare once |
| Initial Enrollment Period | 7 months around your 65th birthday month | Sign up for Medicare and choose your first plan |
| Special Enrollment Periods | Varies | Change plans after events like moving, losing other coverage or your plan leaving your area |
Most people make changes during Annual Enrollment. If you are happy with your current plan, you do not have to do anything; it renews automatically. Still, read your Annual Notice of Change, because premiums, copays, networks and drug lists can all change on January 1.
Check Every Line
Your 2027 premium and deductible
Copays for doctors, specialists and hospital stays
The out-of-pocket maximum
Updates to your formulary, drug tiers and coverage requirements
Whether your doctors, hospitals and pharmacy are still in network
Changes to dental, vision, hearing and other extras
Plans must send the Annual Notice of Change by September 30. It is the single most useful document you get each fall, because it tells you exactly how your plan changes on January 1.
Outside the fall and early-year windows, you generally need a Special Enrollment Period to change plans. Common reasons include:
You May Qualify If
Your plan is leaving your area or ending
You move outside your plan’s service area
You lose employer or union coverage
You qualify for Extra Help or a Medicare Savings Program, or your Medicaid status changes
You want to join a 5-star plan, once a year
Each Special Enrollment Period has its own time limit, so act as soon as the event happens.
Most Medicare Advantage plans require prior authorization for some services, such as certain surgeries, advanced imaging, skilled nursing stays and some drugs. Your doctor usually requests it, but ask whether a planned service needs approval so a denial does not surprise you.
If a request is denied, you or your doctor can appeal. Medicare rules set deadlines for plans to decide, with faster deadlines when waiting could seriously harm your health.
Every Medicare Advantage plan covers emergency care and urgent care anywhere in the U.S., in or out of network, and you do not need prior approval for an emergency. Routine care away from home is a different story: HMOs generally do not cover it, while PPOs cover out-of-network care at a higher cost.
If you spend months away from home each year, ask each plan how it handles care in your second location. It is one of the most common reasons people switch plans mid-year.
If your plan denies a service, a drug or payment for care, you have the right to appeal. The plan’s denial notice explains how. There are several levels of appeal, starting with the plan and moving to independent reviewers.
For problems that are not about coverage, such as customer service or wait times, you can file a grievance with the plan. You can also contact 1-800-MEDICARE or your State Health Insurance Assistance Program for help.
The Part B premium is the one big number not released with the plans. CMS normally announces it in November. The 2026 Medicare Trustees Report projects a 2027 standard premium of about $209.50 a month and a deductible of about $292, up from $202.90 and $283 in 2026. You keep paying it with Medicare Advantage.
If you miss the Annual Enrollment deadline, your current plan renews automatically for 2027, with the changes in your Annual Notice of Change. If you are in Medicare Advantage, you get one more chance from January 1 to March 31, 2027, to switch Medicare Advantage plans or return to Original Medicare and join a Part D plan.
Many Medicare Advantage plans may cover telehealth visits for some services, sometimes at a lower copay than an office visit. Telehealth is convenient for follow-ups and minor issues, but it does not replace confirming that your regular doctors are in network.
Advantages
Often a low or $0 premium
A yearly out-of-pocket maximum
Drug coverage usually included
Many plans may include dental, vision and hearing benefits
One card and one plan
Tradeoffs
Networks; HMOs require in-network care except emergencies
Prior authorization and referrals are common
Copays add up if you use a lot of care
Plans and networks can change every year
Switching to Medigap later may require health questions
If you turn 65 in 2027, your Initial Enrollment Period lasts seven months: the three months before your birthday month, your birthday month and the three months after. Signing up during the first three months means your coverage starts on the first day of your birthday month.
Turning 65 Checklist
Sign up for Part A and Part B, unless you have qualifying employer coverage and choose to delay Part B
Decide between Medicare Advantage and Original Medicare with Medigap
Join a drug plan, or a Medicare Advantage plan with drugs, to avoid a Part D late penalty
If you choose Medigap, buy during your six-month Medigap Open Enrollment Period
Medicare rates every Medicare Advantage and Part D plan from 1 to 5 stars each fall, based on things like preventive care, how well the plan manages chronic conditions, member complaints, customer service and drug pricing accuracy. The ratings are shown in Medicare Plan Finder.
Using Star Ratings
A rating of 4 stars or higher is generally a good sign of quality and service
Five-star plans have a special enrollment period, so you can switch into one once during the year
New plans may not have a rating yet, which is not a bad sign by itself
Ratings measure the plan overall, not how well it covers your specific doctors and drugs
Sometimes a drug you take is not on a plan’s 2027 formulary, or it carries a rule like prior authorization. You still have options:
If Your Drug Is Not Covered
Ask for a transition fill. In the first 90 days of a new plan year or a new plan, plans generally must give you a temporary supply of a drug you were already taking, so you have time to switch or request an exception.
Ask your doctor about alternatives. A covered drug in the same class may work as well and cost less.
Request a formulary or tiering exception. Your doctor submits a statement explaining why you need the drug or a lower copay. Plans must decide within set time limits.
Appeal a denial. If the plan says no, you can appeal, and there are several levels of review.
$700
Maximum 2027 Part D deductible, up from $615.
$2,400
2027 Part D out-of-pocket cap, up from $2,100.
About $36
Average 2027 standalone Part D premium, up less than $1 (CMS).
$7
Projected average drug portion of a Medicare Advantage premium for 2027, down from $11.32.
| Tier | Typical Drugs | Typical Cost |
|---|---|---|
| Tier 1 | Preferred generics | Lowest copay |
| Tier 2 | Generics | Low copay |
| Tier 3 | Preferred brand-name drugs | Moderate copay |
| Tier 4 | Non-preferred drugs | Higher copay or coinsurance |
| Tier 5 | Specialty drugs | Highest coinsurance |
Tier structures vary by plan. Check each plan’s formulary.
Your six-month Medigap Open Enrollment Period starts the first month you are both 65 or older and enrolled in Part B. It happens only once and cannot be restarted. During it, insurers must sell you any Medigap plan they offer in your state, at the same price as people in good health.
If you keep working past 65 with employer coverage and delay Part B, your Medigap Open Enrollment Period waits until you enroll in Part B. Enrolling in Part B early, when you do not need it, starts the clock and can waste this protection.
Step by Step
Check whether you have a guaranteed issue right. For example, your plan is ending or you are within your first year of Medicare Advantage.
If not, check your state’s rules. Some states give extra rights; most allow health questions.
Apply for Medigap before you leave Medicare Advantage. Make sure you are approved first.
Join a Part D plan. Medigap does not cover drugs.
Leave Medicare Advantage at the right time. During Annual Enrollment or the January to March window.
If you have coverage from a current employer, you may not need Medigap yet, and delaying Part B can preserve your Medigap Open Enrollment Period for later. Retiree coverage is different: it may work like a supplement, so compare it with Medigap before dropping it, because you may not be able to get retiree coverage back.
When employer or union coverage that pays after Medicare ends, you generally have a guaranteed issue right to buy certain Medigap plans.
If you buy Medigap during your open enrollment period or with a guaranteed issue right, you generally cannot be denied or charged more for health conditions. However, if you did not have creditable coverage before, an insurer may impose a waiting period of up to six months before covering costs for a pre-existing condition. Prior creditable coverage reduces or removes that waiting period.
If you replace one Medigap policy with another, you generally get 30 days to decide whether to keep the new policy. Pay the premiums for both during that time, and do not cancel your old policy until you are sure about the new one.
You do not have to compare plans alone, and you should not have to pay for help. These are the free options:
Free Help Comparing Plans
Medicare Plan Finder on Medicare.gov, available any time
1-800-MEDICARE (1-800-633-4227), available 24 hours a day, seven days a week
Your State Health Insurance Assistance Program (SHIP), which offers free, unbiased counseling
A licensed insurance agent or broker, who can compare plans from several insurers at no cost to you
Before any call, have your Medicare card, your list of drugs and doses, your doctors and your preferred pharmacies ready. It turns a long conversation into a short one.
The Bottom Line
If you have Medicare and Medicaid, compare dual plans in your county.
People who have both Medicare and Medicaid can qualify for a Dual Special Needs Plan, often called a D-SNP. You need Part A and Part B, must live in the plan’s service area, and must meet the plan’s specific Medicaid eligibility level. Your state Medicaid office can confirm which category of Medicaid you hold.
The Annual Enrollment Period runs October 15 to December 7, 2026, with new coverage taking effect January 1, 2027. Current Medicare Advantage members may also make one switch from January 1 to March 31, 2027. Dual-eligible members may have extra enrollment opportunities, so confirm your timing with your State Health Insurance Assistance Program (SHIP).
Coverage under your current plan continues through December 31, 2026, and you will receive a non-renewal notice first. You can choose another plan, including a different dual plan if one serves your area, during Annual Enrollment or a Special Enrollment Period. You generally also have a guaranteed issue right to buy certain Medigap plans, typically within 63 days after coverage ends.
A Dual Special Needs Plan is a type of Medicare Advantage plan built for people enrolled in both Medicare and Medicaid. It works alongside your Medicaid benefits to coordinate hospital, medical and prescription coverage. How closely each plan works with your state Medicaid program varies, so read the plan documents carefully.
Dual plans may include dental, vision, hearing, over-the-counter allowances, transportation or meal benefits, depending on the plan and your area. Not all plans offer all benefits, and amounts can change for 2027. Review the Summary of Benefits for each D-SNP available in your county to see what is actually offered.
Yes. Joining a D-SNP does not replace your Medicaid, because the plan is designed to work with it. You still need to keep up with your state’s Medicaid renewal requirements, since losing Medicaid eligibility can affect whether you can remain in the dual plan.
Some insurers are leaning further into Special Needs Plans for 2027, with UnitedHealthcare adding 40 SNPs. Others, including Molina and Horizon BCBS New Jersey, are moving to SNP-only offerings. Which dual plans exist in your area still depends on your county, so check the 2027 options at your ZIP code.
Your state Medicaid office, along with your Medicaid card and approval letters, will show which level of coverage you have. This matters because some dual plans accept only certain Medicaid categories. If the paperwork is unclear, your State Health Insurance Assistance Program (SHIP) can help you sort it out at no cost.
D-SNPs include Part D drug coverage, but each plan has its own formulary and pharmacy network. Check that every medication you take is listed and note any prior authorization or step therapy rules. Drug lists can change for 2027, so verify again before enrolling.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 18 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.