Dual Special Needs Plans (D-SNPs) and Key 2026 Changes: What Dual Eligibles Need to Know During Medicare Enrollment | iPharmaCenter

Dual Special Needs Plans (D-SNPs) are Medicare Advantage plans designed for individuals eligible for both Medicare and Medicaid, offering coordinated coverage that integrates medical, prescription, and supplemental benefits to address complex needs. These plans cover Medicare Parts A, B, and often D alongside Medicaid services like long-term care and behavioral health support, typically with low or no cost-sharing.

UnderstandingD-SNPs for Dual Eligibles

D-SNPs target "dual eligibles", people with both Medicare and full or partial Medicaid-who often face higher health needs and financial challenges. These plans streamline care by aligning Medicare and Medicaid providers, reducing gaps in coverage, and adding extras like transportation, dental, vision, and over-the-counter (OTC) allowances. Enrollment has surged, with D-SNPs now serving a majority of duals in Medicare Advantage due to better coordination and supplemental perks.

Beneficiaries qualify automatically upon Medicaid eligibility confirmation, and plans must verify status to ensure proper benefit delivery. During enrollment periods, duals can switch plans if aligned with rules, making 2026 updates critical for informed decisions.

Major2026 Benefit Changes:

End of VBID ModelA pivotal shift for 2026 is the termination of the CMS Value-Based Insurance Design (VBID) model, which previously enabled enhanced benefits like $0 copays on all Part D drugs in participating D-SNPs. Without VBID, many plans will revert to standard copayments for prescriptions, though Extra Help recipients remain protected from exceeding low-income subsidy levels, and some insurers may offer alternative savings programs.Supplemental benefits face stricter criteria too. Non-medical extras, such as healthy food credits or home utilities via OTC allowances, now require verification of a qualifying chronic condition like diabetes, hypertension, or cardiovascular disease. This CMS codification for Special Supplemental Benefits for the Chronically Ill (SSBCI) ensures targeted use, with UnitedHealthcare noting 95% of its eligible members already verified—though status does not transfer between carriers.

Enrollmentand Operational Updates

CMS's 2026 final rule clarifies D-SNP enrollment timing, emphasizing alignment with Medicaid status to prevent coverage disruptions. Duals can enroll during the Annual Enrollment Period, Initial Enrollment Period, or Special Enrollment Periods tied to life events like moves or eligibility changes, with some states mandating "exclusively aligned" or Fully Integrated D-SNPs (FIDE-SNPs) starting January 1. Preparation for 2027 includes integrated ID cards and single health risk assessments across Medicare and Medicaid, requiring plans to update systems in 2026. Broader rules tighten prior authorizations, appeals, and marketing transparency, indirectly shaping D-SNP offerings.

Implications During Medicare Enrollment Season

These updates position 2026 as a transition year toward more integrated, accountable D-SNP care, potentially reshaping plan competition and beneficiary choices. Dual eligibles should review Annual Notices of Change, confirm Medicaid status, and compare plans for verified benefits and networks before December 7. Brokers and advocates can guide clients toward compliant options amid state variations, like Delaware's shift to exclusively aligned plans or Tennessee's FIDE-SNP push.