D-SNP: Dual-Eligible Special Needs Plan (FIDE-SNP, HIDE-SNP) Explained (2026)

What D-SNPs are (and aren't)

D-SNPs are Medicare Advantage plans with a specific focus: serving people who have both Medicare and Medicaid coverage. Key features:

• Medicare Advantage structure — D-SNPs are Part C plans, governed by Medicare Advantage rules with additional D-SNP-specific requirements.
• Medicaid integration — D-SNPs must have a contract with the state Medicaid program (Ohio Department of Medicaid) and coordinate benefits with the member's Medicaid coverage.
• Specialized care management — D-SNPs are required to have care coordination teams familiar with managing both Medicare and Medicaid benefits, often with bilingual capabilities and cultural competency for the populations served.
• Often enhanced supplemental benefits — many D-SNPs offer enhanced dental, vision, hearing, transportation, and over-the-counter benefits beyond what regular MA plans provide.

D-SNPs are NOT:

• Regular Medicare Advantage plans — they have additional requirements and benefits.
• Medicaid managed care alone — they integrate with Medicaid but the Medicare side is the primary structure.
• Only for full duals — some D-SNPs accept partial duals (people with MSPs like QMB but not full Medicaid).

Who qualifies for a D-SNP

D-SNPs are restricted to people in specific dual-eligibility categories:

• Full Benefit Dual-Eligibles (FBDEs) — people with both Medicare and full Medicaid coverage. Maximum benefit from D-SNP integration.
• Qualified Medicare Beneficiaries (QMB) without other Medicaid — Medicare beneficiaries whose Medicaid benefits are limited to MSP cost-sharing assistance.
• Specified Low-Income Medicare Beneficiaries (SLMB) and Qualifying Individuals (QI) — narrower MSP categories. Some D-SNPs accept SLMB/QI; others restrict to FBDE only.

Each D-SNP specifies which dual-eligibility categories it serves. Your Medicaid eligibility category, determined by the state Medicaid agency, determines which D-SNPs you can join.

The three D-SNP integration categories

CMS distinguishes three categories of D-SNPs by the degree of Medicare-Medicaid integration:

The trend across U.S. dual-eligible markets is toward greater integration — FIDE-SNP and HIDE-SNP rather than coordination-only structures. Ohio's January 2026 transition to Next Generation MyCare with FIDE-SNP-based MCOs reflects this trend.

FIDE-SNP and Next Generation MyCare Ohio

Next Generation MyCare Ohio, launched January 1, 2026, uses the FIDE-SNP structure to combine Medicare and Medicaid into a single integrated plan for dual-eligibles in Ohio:

• Four MCOs: Anthem Blue Cross Blue Shield, Buckeye Health Plan, CareSource, and Molina Healthcare of Ohio.
• Statewide rollout: January 1, 2026 (first 29 counties); April 1 (10 NW/central counties); May 1 (21 central-north counties); June 1 (10 SE counties); July 1 (9 E counties); August 1 (remaining ~9 SE counties).
• One ID card, one set of benefits, one care coordination team for both Medicare and Medicaid services.
• Integrated benefits: medical, behavioral health, prescription drugs (Medicare Part D), long-term services and supports (Medicaid HCBS waiver services for those eligible).
• Replaces the MyCare Ohio MMP demonstration (Medicare-Medicaid Plan) which served 29 counties through December 31, 2025.

See our Next Generation MyCare Ohio guide for the full 2026 transition details.

HIDE-SNP and CO-DSNP

HIDE-SNP (Highly Integrated Dual-Eligible Special Needs Plan):

• Medicare and Medicaid administered by related entities (often the same company's Medicare and Medicaid divisions).
• Common care management across both programs.
• Less integrated than FIDE-SNP but more than coordination-only.
• Available in some Ohio counties, though Next Generation MyCare Ohio's expansion is making HIDE-SNP less common.

CO-DSNP (Coordination-Only D-SNP):

• Medicare and Medicaid remain as separate plans with separate ID cards, billing, and member services.
• Administrative coordination only — the D-SNP sponsor coordinates information between Medicare and Medicaid but doesn't integrate the benefits.
• No longer permitted in Ohio as of 2026 under the Next Generation MyCare transition. Existing CO-DSNP enrollees transitioned to FIDE-SNP or other coverage options.

How D-SNPs differ from regular Medicare Advantage

Compared to standard Medicare Advantage plans, D-SNPs typically offer:

• $0 or very low premiums — D-SNPs are designed to be affordable for low-income beneficiaries.
• Enhanced supplemental benefits — dental, vision, hearing, transportation, over-the-counter cards, fitness benefits, and meals after hospital discharge.
• Lower or $0 cost-sharing — many D-SNPs have $0 copays for covered Medicare services. (Medicaid pays Medicare's deductibles and copays for duals.)
• Dedicated care coordination — care teams familiar with dual-eligible populations and able to navigate both Medicare and Medicaid.
• Higher per-member resource intensity — D-SNPs receive higher CMS payments to serve more complex populations.

Choosing a D-SNP in Ohio

For Ohio dual-eligibles in 2026, the primary D-SNP choices depend on your county:

• Counties with active Next Generation MyCare Ohio: choose from Anthem, Buckeye, CareSource, or Molina. All four operate as FIDE-SNPs with integrated Medicare + Medicaid + HCBS waiver services.
• Counties not yet in MyCare: traditional D-SNPs from carriers like UnitedHealthcare Dual Complete, Humana Gold Plus, Aetna Medicare Dual Choice, or others. Verify the specific D-SNP type (HIDE-SNP vs older arrangements) and Medicaid coordination structure.

Comparison factors:

• Provider network compatibility with your current doctors.
• Specific supplemental benefits offered (dental amounts, OTC card values, transportation rides).
• Care coordination team experience with your specific conditions.
• Pharmacy network for your prescriptions.
• Geographic service area for any travel you anticipate.