AWCA Resource Center
AWCA Resource Center

Medicaid Specials

Dual Eligible Plan (D-SNP)

A Dual Eligible refers to individuals who have Medicare, the health insurance for seniors age 65 or older and people with disabilities, while simultaneously receiving Medicaid, medical assistance for low-income individuals.

Dual eligibles can receive more efficient medical services by enrolling in a D-SNP (Dual Special Needs Plan), which integrates the benefits of both insurances into one. Under federal guidance, D-SNP plans are managed according to unique names and operating policies in each state.

*OBBBA (One Big Beautiful Bill Act) implementations may affect eligibility and program details.

Three Types of D-SNPs

D-SNPs are divided into three types based on the level of integration, with FIDE SNP being the highest level of full integration.

  • CO D-SNP (Coordination-Only): A basic plan that coordinates Medicare and Medicaid benefits. The management entities for the two insurances remain separate.
  • HIDE SNP (Highly Integrated): A highly integrated plan where a single insurance carrier manages most Medicare and Medicaid services.
  • FIDE SNP (Fully Integrated Dual Eligible SNP): A fully integrated plan where a single insurance carrier provides 100% integrated management of Medicare and Medicaid (including MLTSS long-term care services) benefits. In New Jersey, major carriers operate FIDE SNPs, and available plans may vary by county.

Similar Program Names by State:

  • New Jersey, Massachusetts, etc.: FIDE SNP
  • New York: MAP (Medicaid Advantage Plus) — A New York-specific integrated plan combining D-SNP and Medicaid Long-Term Care (MLTC)
  • California: Medi-Medi Plans (Official Name)

Eligibility

  • D-SNP (CO D-SNP / HIDE SNP): Anyone who is dually eligible for both Medicare and Medicaid can consider enrollment. Receiving MLTSS (long-term care) is not required.
  • FIDE SNP (New Jersey Criteria): Must meet all four of the following conditions:
    • Hold Medicare Parts A and B
    • Hold full NJ Medicaid (NJ FamilyCare)
    • Not enrolled in a PACE program
    • Resident of New Jersey

       

*Receiving MLTSS (Long-Term Care) itself is not a mandatory requirement for FIDE SNP enrollment. However, those receiving MLTSS can also join a FIDE SNP to have all services managed in one place.

D-SNP Benefits

D-SNPs coordinate Medicare and Medicaid benefits and include various additional services linked to state Medicaid.

Minimizing Medical and Drug Costs (Cost Sharing)

  • Premium: For those receiving full Medicaid medical benefits, there is no monthly premium, and there are no out-of-pocket costs (copays) for hospital visits or tests.
  • Copay: Generally, there are no out-of-pocket costs for In-Network doctor visits, specialist visits, tests, or hospitalizations. However, Medicaid beneficiaries who only receive premium assistance (QI, SLMB, etc.) from the state may pay some copays.
  • Prescription Drugs: Through Medicare Part D Extra Help, most prescription drug copays are eliminated, regardless of annual limits.

Benefits Card (OTC & Grocery)

  • OTC (Over-the-Counter) Support: Monthly or quarterly credits are provided to purchase non-prescription drugs, vitamins, and first-aid supplies. Amounts may be slightly lower than FIDE SNP.
  • Grocery & Utilities: Provided only to eligible individuals with chronic conditions (diabetes, hypertension, etc.) to pay for groceries or electricity/gas bills.

Supplemental Medical Benefits

  • Dental: Provides comprehensive dental benefits, including not only basic exams but also fillings, crowns, dentures, and implants within an annual limit.
  • Vision: Supports annual eye exams and a set amount for prescription glasses.
  • Hearing: Supports hearing exams along with the cost of hearing aids and fitting.

Transportation & Wellness

  • Medical Transportation: Provides a set number of rides (Uber/Lyft or dedicated vans) for doctor appointments and pharmacy visits.
  • Fitness: Provides free gym memberships such as Silver&Fit or SilverSneakers.
  • 24-Hour Nurse Line: Provides telephone consultation services with professional nurses 24/7 for urgent health advice.

FIDE SNP Benefits

FIDE SNP benefits from major New Jersey carriers (Horizon, UnitedHealthcare, Aetna, Wellcare, etc.) are as follows:

Medical Costs (Cost Sharing)

  • Copay: Doctor visits, specialist visits, and hospitalization costs are fully waived.
  • Prescription Drugs: Most prescription drug copays are eliminated, including Medicare Part D (Extra Help).

Integrated Card Benefits (OTC & Grocery)

  • OTC (Over-the-Counter) Support: Monthly or quarterly amounts are loaded onto a card to purchase supplements and non-prescription drugs at CVS, Walgreens, etc.
  • Grocery & Utilities: Most FIDE SNP plans provide an integrated card for purchasing groceries or paying utility bills (electricity, gas, water). (Approximately $150–$300 per month depending on the plan).

Supplemental Benefits

  • Dental: Covers comprehensive dental care, including implants, dentures, and scaling within an annual limit.
  • Vision: Supports annual eye exams and the cost of purchasing glasses/contact lenses.
  • Hearing: Provides hearing exams along with hearing aid costs and fitting services.

Transportation & Wellness

  • Provides unlimited or a set number of rides (Uber/Lyft or dedicated vans) for hospital visits or pharmacy use.
  • Free Fitness Membership: Access to local gyms and the YMCA, home fitness kits, and online exercise classes through SilverSneakers or Silver&Fit.
  • Healthy Rewards: Rewards users with gift cards or cash-equivalent points for completing preventive activities such as regular checkups, flu shots, and blood sugar tests.
  • In-home Visits: Provides the ‘HouseCalls‘ service where a specialist visits your home annually to check your health status and create a personalized care plan.
  • 24-Hour Nurse Consultation: Free phone consultations with professional nurses are available 24/7 for health inquiries or emergencies.
  • Wellness Digital App: Access to real-time health tracking and wellbeing coaching (diet, exercise, etc.) via a smartphone app.

Key Differences

CategoryD-SNP (CO/HIDE)FIDE SNP
Key FeaturesMedicare and Medicaid are operated by separate entities, with the insurance company acting as a bridge.A single insurance company integrates all services and finances, directly managing all decisions.
Ease of ManagementManagement of medical and long-term care (MLTSS) is separate, and you may need to carry separate Medicare and Medicaid cards.Integrated Management (Access hospital, pharmacy, and caregiver services all at once with a single ID card).
CommunicationYou may need to contact the insurance carrier for medical inquiries and the county for social services separately.One-Stop Service through a dedicated Care Manager who handles both medical and social service needs.
Dental/VisionVery High (Relatively generous limits for implants and vision hardware allowances).Moderate (Focuses on standard Medicaid coverage; additional limits may be lower).
Benefit CardUsage is often restricted to OTC items rather than groceries. Chronic condition verification is required.Higher limits for groceries and utilities (usually $50–$100 more per month). Higher combined amounts (up to approx. $300/month).
TransportationPrimarily focused on medical purposes. Limited to a set number of trips (e.g., 24–48 times per year).Unlimited or broader support. Available for groceries, dental/vision visits, and affiliated gyms as well as hospitals.

2026 Changes & Reminders (OBBBA Updates)

  • Alignment: Federal and state governments (CMS/NJ DHS policies) actively encourage enrollment in FIDE SNPs, which unify Medicare and Medicaid carriers into one for administrative efficiency.
  • Automatic Transition: Some D-SNP enrollees may be automatically transitioned to a FIDE SNP with enhanced benefits according to state guidelines; you must check enrollment notices sent by mail.
  • Monthly Switching: Starting in 2025, full-benefit dual eligibles have a Monthly Integrated Care SEP (Special Enrollment Period) that allows switching between integrated plans (FIDE SNP, HIDE SNP, etc.) every month.

If you are receiving MLTSS, choose a plan based on your priorities:

  • If a wider doctor network or higher dental surgery limits are important → D-SNP
  • If cash-equivalent support (grocery card) and convenient administration are important → FIDE SNP

How to Apply

D-SNP

  • Online: Medicare.gov — Find a Medicare Plan or individual insurance carrier websites.
  • Phone: 1-800-MEDICARE (1-800-633-4227; 24/7) or individual insurance carrier phone numbers.

    *Benefits generally begin on the 1st of the month following approval.

FIDE SNP (New Jersey)

FIDE SNP is a fully integrated dual-eligible plan that manages Medicare and Medicaid benefits in one health plan. Choose the method that fits your situation:

  • To enroll in a FIDE SNP without MLTSS (Long-Term Care): Contact 1-800-MEDICARE (1-800-633-4227) or contact the specific insurance carriers listed below directly.
  • If you also need MLTSS (Long-Term Care): Contact your local county ADRC first for an MLTSS clinical screening. Once approved, request integration with a FIDE SNP carrier.

Bergen County Residents: Contact the Bergen County Division of Senior Services.


*Once MLTSS is approved, you must contact your chosen FIDE SNP insurance carrier and request to “Fully Integrate” your Medicare and Medicaid benefits with that carrier.

Online/Phone: Individual FIDE SNP carriers (refer to the comparison table below or the official NJ DHS page).

*Once the process is complete, Medicaid management will automatically transfer from the state to your chosen FIDE SNP carrier. Keep your old cards, but use the single ID card issued by the FIDE SNP for all benefits.

FIDE SNP Overview by Insurer (2026)

CarrierD-SNP (Plan Name)FIDE SNP (Plan Name)Contact & Website2026 Key Features
Horizon BCBSHorizon NJ TotalCareHorizon NJ TotalCare1-800-543-5656 (TTY: 711) / Horizonblue.comNew Jersey's largest network. Provides up to $3,000+ in annual benefits via the Horizon &more Card.
UnitedHealthcareUHC Dual CompleteUHC Dual Complete1-800-514-4911 (TTY: 711) / UHC.comEnhanced UCard benefits. Provides approximately $246+ in monthly credits for groceries/utilities, etc.
AetnaAetna Medicare D-SNPAetna Medicare FIDE1-844-362-0934 (TTY: 711) / AetnaBetterHealth.com/NJStrong CVS pharmacy network. Provides an additional benefit card of approximately $255 per month.
Wellcare (Fidelis)Wellcare Dual AccessFidelis Dual Align1-866-892-8340 (TTY: 711) / Fideliscare.orgExpertise in Medicaid management. Excellent approval and coordination processes for MLTSS

(Long-Term Care) services.
WellpointWellpoint Dual AdvantageFull Dual Advantage1-844-765-5160 (TTY: 711) / Wellpoint.comCommunity-focused service. Concentrates on simplified approval procedures and practical supplemental services.

*Carrier contact info and plan names may change annually. Check Medicare.gov or FIDE SNP Consumer and Provider Information for the latest info.

Contact

  • NJ SHIP (State Health Insurance Assistance Program): 1-800-792-8820 (Free counseling from state-trained experts)
  • AWCA provides free consultations regarding these plans: (201-862-1665 / info@awcanj.org)

Resources

Resources

Medicaid Specials