Dual Eligible Special Needs Plans (D-SNPs) can be complicated. CMS rules as well as Medicaid rules of eligibility seem to be constantly changing. But understanding D-SNP changes will benefit both you and your clients. Here’s what you need to know about these plans for 2026.
The End of VBID Means Changes to Benefits
The Value Based Insurance Design (VBID) model was introduced by CMS with the goal of lowering out-of-pocket costs and adding supplemental benefits that would improve health outcomes. Because the model did not reach the desired goal, the program was terminated at the end of 2025. As a result, there have been some benefit changes that directly impact D-SNP enrollees:
- Many enhanced benefits have been replaced with SSBCI (Special Supplemental Benefits for the Chronically Ill). SSBCI must be primarily health related and directly result in improved health outcomes and reduced hospitalizations. Beneficiaries must have one or more chronic conditions as defined by CMS. While most SSBCI benefits are offered with Chronic Condition Special Needs Plans (C-SNPs), CMS recognizes the high prevalence of chronic conditions in the D-SNP population and gives carriers the flexibility to add these benefits to dual eligible plans.
- The end of VBID also means the end of blanket $0 Part D prescriptions. Plans can offer drug savings through LIS and must follow LIS cost-sharing rules.
D-SNP Eligibility Rules
Income and asset requirements for D-SNPs can change every year. While the federal government sets general limits, each state administers their own Medicaid program and can set their own thresholds for income and assets. In Texas, the eligibility rules for Medicaid are set through a combination of federal requirements and the Texas Health and Human Services Commission.
As of January 1, 2026, the federal government requires some adult Medicaid beneficiaries to work or volunteer in their communities. This, coupled with more frequent verification and tighter documentation, may result in some people losing their coverage, even if they still qualify.
Tighter Integration Between Medicare and Medicaid Benefits
CMS is moving toward stronger integration between Medicare and Medicaid to improve both the member experience and health outcomes of individuals enrolled in D-SNPs. Integrated plans simplify coverage for enrollees by coordinating benefits through a single plan. This means one ID card, and the alignment of processes, including enrollment, care management, and grievance and appeals.
On January 1, 2026, Texas began moving to an integrated D-SNP model in some key counties, including Bexar, Dallas, El Paso, Harris and Hildalgo. Dual eligible members who were in a Medicare-Medicaid Plan (MMP) will transition to integrated D-SNPs that coordinate with STAR+PLUS Medicaid plans.
D-SNP Special Enrollment Periods introduced in 2025 make it easier for those who are dual eligible to switch to a fully integrated plan. It also protects D-SNP enrollees who lose their Medicaid status by offering a grace period that allows time to reestablish their eligibility without losing their coverage.
Enrollment in D-SNPs Continues to Grow
The number of SNPs being offered by carriers continues to grow, including D-SNPs. While carriers have tried to control growth and stabilize finances by reducing the number of MA plans they offer, they see opportunities with D-SNPs. Dual eligible enrollees come with higher risk scores, which means they garner higher monthly payments from CMS. This helps insurers by providing more predictable financial margins.
As a broker who is always looking for opportunities to grow your business, D-SNPs should not be overlooked. In 2026, 78% of SNP enrollees, or nearly 6.5 million people, are enrolled in a D-SNP.
You can play a major role in helping D-SNP enrollees. They are often dealing with medically complex issues and are confused by the dual coverage. You can help them understand and maximize their benefits, reduce their out-of-pocket expenses and help them improve their health outcomes.
Tips to best serve this population:
- Be familiar with the D-SNPs available in your area and the benefits they offer.
- Understand the rules for Medicaid eligibility in your state, and help enrollees confirm that their level of eligibility matches the plan’s requirements.
- Be familiar with special enrollment periods for D-SNPs to prevent enrollment mistakes.
Medicare is always changing. The experienced team at PTT Financial is here to help you stay informed and up to date. Learn more today.