Medicare Plans for People with Medicaid

Improving D-SNPs in Wisconsin

The Department of Health Services (DHS) is working to improve the experience members have with both Medicare and Medicaid coverage in Wisconsin. See what we’re doing and how you can get involved on the Improving Access to Medicare and Medicaid Coverage webpage.

Dual Eligible Special Needs Plans

A Dual Eligible Special Needs Plan, also called a D-SNP, is a kind of Medicare Advantage plan for people who have both Medicare and Medicaid.

Dual Eligible Special Needs Plans cover hospital, medical, and prescription costs—all in one plan, with little or no costs. The plans have provider networks. You may need to see doctors who are in your plan's network to have your bills covered.

Dual Eligible Special Needs Plans work best when you’re enrolled in the same company’s Medicaid HMO (health maintenance organization) or MCO (managed care organization). That way, the same company provides both your Medicare and Medicaid coverage.

Video explanation

This video explains what it means to have both Medicare and Medicaid for your health insurance using an example of someone with a disability who is getting Medicare.

Watch the video in Spanish.

Coordinate your Medicare and Medicaid

Having coordinated plans makes it easier to find doctors who take your insurance.

Medicare and Medicaid usually don't coordinate if you get your insurance through the government or from different companies.

Two unlocked puzzle pieces when Medicare and Medicare are not coordinated

Medicare and Medicaid benefits are coordinated when you have a Medicare Dual Eligible Special Needs Plan and Medicaid HMO or MCO from the same company.

Two locked puzzle pieces showing coordinated Medicare and Medicaid insurance

Is a Dual Eligible Special Needs Plan right for me?

To find out if a Dual Eligible Special Needs Plan is right for you:

Read the FAQs (frequently asked questions) or our brochure, Medicare and Medicaid brochure, P-03556 (PDF).
See which plans you can get using our D-SNP spreadsheet (Excel) and/or Medicare.gov.
Make sure the plan covers your prescription drugs using the Medicare.gov Plan Finder.
Check if your doctors are in the plan's network by calling the plan or searching their website.

Get free and unbiased help with Medicare from the State Health Insurance Assistance Program.

See which Dual Eligible Special Needs Plans are available in your county

Use the D-SNP spreadsheet to filter for plans (Excel)

For some plans and costs depend on what type of Medicaid you have. People with full Medicaid and/or the Qualified Medicare Beneficiary (QMB) Medicare Savings Program have lower costs than people with other types of Medicaid. Learn more in the Medicare Savings Programs publication, P-10062.

Default enrollment notices

If you’re enrolled with an SSI Medicaid HMO and getting Medicare for the first time, you may be enrolled with a Medicare Dual Eligible Special Needs Plan offered by the same HMO you currently have for your SSI Medicaid. This is called “default enrollment.”

These are examples of default enrollment notices sent by Dual Eligible Special Needs Plan organizations:

The following companies conduct default enrollment:

Elevance Health (Anthem): Anthem Full Dual Advantage (HMO D-SNP) (H9525-003)
iCare: iCare Medicare Plan (HMO D-SNP) (H2237–001)
Managed Health Services (WellCare): WellCare Dual Access (HMO D-SNP) (H8189-001)
UnitedHealth Care: UnitedHealthcare Dual Complete WI-D-002 (HMO-POS D-SNP) (H3794-002)

Resources for professionals

Professionals can access D-SNP resources on the GWAAR Medicare Outreach and Assistance Resources webpage under Dual Special Needs Plans (D-SNPs) or the State Health Insurance Assistance Program Technical Assistance Center (login required).