Medicare + Medicaid
Medicare Advantage Dual-Eligible Special Needs Plans (D-SNP), gently explained.
These plans may be available to anyone who has both Medical Assistance from the State and Medicare. A Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) coordinates your benefits into one plan and often includes extras Original Medicare doesn't cover.
What is a Dual-Eligible Special Needs Plan?
A Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) is a type of Medicare Advantage plan built specifically for people enrolled in both Medicare and Medicaid. To qualify, a beneficiary must have both Medicare and Medicaid. The plan coordinates your benefits into one plan and often includes extras that Original Medicare doesn't cover.
Eligibility and benefits vary by county. We'll help you confirm whether you qualify and compare the D-SNP options available where you live.
Potential extra benefits
- $0 monthly plan premium (for most who qualify)
- Dental, vision, and hearing coverage
- Over-the-counter (OTC) allowance
- Transportation to medical appointments
- Healthy food or grocery allowance (plan-dependent)
- Fitness membership (e.g., SilverSneakers®)
Benefits and eligibility vary by plan, county, and level of Medicaid assistance. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
Do I qualify?
To enroll in a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP), you must have both Medicare and Medical Assistance from the State. The fastest way to know if you qualify is a quick, free eligibility review with our team — call (262) 705-2363.
Dual-Eligible coverage in Wisconsin, gently explained
If you (or someone you love) has both Medicare and Medical Assistance from the State, you may be eligible for some of the most generous coverage available — and yet most people have never even heard of it. A Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) brings your medical care, hospital coverage, prescriptions, and extra benefits together into one plan, often at $0 a month. We'd love to help you see what's possible.
These plans may be available to anyone who has both Medical Assistance from the State and Medicare. We'll walk you through eligibility in plain language and confirm what applies to your situation.
We work with the Medicare Advantage Dual-Eligible Special Needs Plan carriers that serve Wisconsin and always start by looking up what's actually offered in your area — and we make sure your doctors and your pharmacy are in the network before recommending anything.
Many D-SNPs include real, life-improving extras: routine dental (including dentures), eye exams and glasses, hearing aids, a monthly OTC allowance for things like vitamins and pain relievers, a healthy-food or grocery allowance, rides to medical appointments, telehealth, a SilverSneakers® gym membership, and a dedicated care coordinator you can call by name. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
About Special Supplemental Benefits for the Chronically Ill (SSBCI): You may be eligible for Special Supplemental Benefits for the Chronically Ill (SSBCI) — such as flexible allowances for living expenses like groceries, rent, or utilities — if you have one or more qualifying chronic conditions and meet CMS's definition of a chronically ill enrollee. Eligibility for SSBCI is separate from D-SNP eligibility and must be confirmed through review of your claims and/or medical records. SSBCI benefits begin the month after eligibility is verified. New members may experience delays if medical records are not yet available.
Questions families ask us most often
"What if I pick a plan and don't love it?"
You're not locked in. Dual-eligible members get a Special Enrollment Period and can change plans once per quarter during the first three quarters of the year, plus during the Annual Enrollment Period (Oct 15 – Dec 7). We're here to help you switch if anything stops feeling right.
"Will a D-SNP take away my Medicaid?"
No — your Medical Assistance from the State stays exactly as it is. The Medicare Advantage Dual-Eligible Special Needs Plan works alongside it: Medicare pays first, Medicaid fills in the gaps, and the plan coordinates everything so you don't have to.
"How do I know if I qualify for Medical Assistance from the State?"
We can walk you through the basics in plain language. If you're already enrolled in Medical Assistance from the State, your award letter is all the proof we need to start reviewing D-SNP options with you.
"Is a D-SNP really $0?"
For most folks at the "full dual" level, yes — $0 monthly premium, $0 primary care copays, and very low or $0 prescription copays. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. We'll quietly check your level for you before you enroll, so you know exactly what to expect. Please contact the plan for further details.
Third-Party Marketing Organization (TPMO) Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day / 7 days a week, to get information on all of your options. Calling the number on this page will connect you with a licensed insurance agent. We are not connected with or endorsed by the United States government or the federal Medicare program.
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