In short
- D-SNPs are only for people with both Medicare and Medicaid, and every D-SNP includes Part D drug coverage.
- For 2027, CMS data shows 12 D-SNPs in Nebraska: 6 highly integrated with Medicaid and 6 coordination-only.
- Lancaster County has 10 D-SNPs and 26 regular Medicare Advantage plans for 2027.
- People with full Medicaid can join an integrated D-SNP from the same company as their Medicaid plan in any month.
- Plan availability, networks and benefits vary by county and change every year.
D-SNP vs Regular Medicare Advantage at a glance
| Feature | D-SNP | Regular Medicare Advantage |
|---|---|---|
| Who can join | People with Parts A and B who also have Medicaid; each plan sets which Medicaid levels it accepts | Anyone with Parts A and B who lives in the plan's service area |
| Medicaid coordination | Required; D-SNPs contract with Nebraska Medicaid | Not built in; Medicaid still pays second if you have it |
| Integration in Nebraska, 2027 | 6 highly integrated D-SNPs and 6 coordination-only D-SNPs statewide | Not applicable |
| Drug coverage | Always included | Usually included; some plans have none |
| Care coordination | Built into every special needs plan | Varies by plan |
| Plans in Lancaster County, 2027 | 10 | 26 |
| When you can join | Integrated D-SNPs: any month with full Medicaid, if aligned with your Medicaid plan; others at set times | Annual Enrollment, October 15 to December 7, the January to March window, or another Special Enrollment Period |
| Your share of costs | Often little to nothing with full Medicaid or QMB, because Medicaid covers Medicare cost sharing | Plan copays apply, but QMB members cannot be billed for Medicare cost sharing |
| Out-of-network costs in PPOs | Federal limits on some out-of-network cost sharing since 2026 | Set by the plan within Medicare rules |
| If you lose Medicaid | You may no longer qualify; a Special Enrollment Period lets you choose new coverage | Your plan does not change |
The short answer
If you have Medicare and full Medicaid in Nebraska, a D-SNP, especially an integrated one from the same company as your Heritage Health plan, is often the simpler fit because one company coordinates both. A regular Medicare Advantage plan can still make sense if your doctors are only in its network, so compare doctors and drugs either way.
If you have both Medicare and Medicaid, you have more plan choices than most people, and more chances to change them. That is useful and confusing at the same time. The core question is whether a plan built for dual eligibles, a D-SNP, serves you better than a regular Medicare Advantage plan.
What is the difference between a D-SNP and a regular Medicare Advantage plan?
A Dual Eligible Special Needs Plan is a type of Medicare Advantage plan that only people with both Medicare and Medicaid can join. Medicare's handbook explains that D-SNPs contract with your state Medicaid program to coordinate your Medicare and Medicaid benefits. Every special needs plan must include Part D drug coverage and care coordination.
A regular Medicare Advantage plan is open to anyone with Parts A and B in its service area. If you have Medicaid, it still pays second, but the plan itself does not coordinate with Medicaid. The basics of these plans are on our D-SNP page.
Some D-SNPs go further. Medicare calls them integrated D-SNPs: they combine your Medicare benefits and most or all of your Medicaid benefits through one company.
What D-SNPs are available in Nebraska for 2027?
CMS plan data for 2027 shows 12 D-SNPs in Nebraska from six companies: UnitedHealthcare, Wellcare (Centene, the Medicare partner of Nebraska Total Care), Molina, Aetna, Humana and Devoted Health. Six are highly integrated with Medicaid, and six are coordination-only.
| Area, 2027 | D-SNPs | Highly integrated | Coordination-only | Regular MA plans |
|---|---|---|---|---|
| Nebraska statewide | 12 | 6 | 6 | 30 |
| Lancaster County (Lincoln) | 10 | 4 | 6 | 26 |
| Douglas County (Omaha) | 10 | 4 | 6 | 24 |
| Hall County (Grand Island) | 8 | 4 | 4 | 21 |
Nebraska DHHS says each of its three Heritage Health Medicaid companies, Molina, Nebraska Total Care and UnitedHealthcare Community Plan, runs a highly integrated D-SNP. Devoted Health's D-SNPs grow from 14 counties in 2026 to 42 in 2027, including Lancaster. Plan availability, networks and benefits vary by county and change every year. Compare company-level details on our list of D-SNP plans in Nebraska.
How do the enrollment rules differ?
Dual eligibles get more chances to change plans than other people with Medicare. These rules took effect for enrollments starting in 2025:
- Integrated care Special Enrollment Period. If you have full Medicaid, you can join or switch to an integrated D-SNP once a month, when it is offered alongside your Medicaid plan. Medicare's handbook describes this as joining an integrated D-SNP "using the same insurer as your Medicaid plan."
- Monthly dual and Extra Help Special Enrollment Period. Once a month, you can switch standalone drug plans, or leave Medicare Advantage for Original Medicare with a drug plan.
- Regular windows. To join a coordination-only D-SNP or a regular Medicare Advantage plan, you generally use the Annual Enrollment Period (October 15 to December 7, 2026, for 2027 coverage), the Medicare Advantage Open Enrollment Period (January 1 to March 31), or another Special Enrollment Period.
Changes made with a monthly Special Enrollment Period start the first day of the next month. Under a separate federal rule that takes effect with 2027 plans, a company that offers both a Heritage Health plan and a D-SNP may limit new enrollment in some of its D-SNPs to members of its own Heritage Health plan. How that applies varies by plan, so confirm with the plan or the Heritage Health Enrollment Center (1-888-255-2605) before you switch.
How do costs compare for dual eligibles?
For many dual eligibles, Medicaid covers most Medicare costs either way. If you have full Medicaid or the QMB program, Medicaid generally covers your Medicare premiums and cost sharing, and Medicare providers are not allowed to bill QMB members for Medicare deductibles, coinsurance or copays. That protection applies in regular Medicare Advantage plans too; if you are billed, contact the plan and the provider.
Duals also get Extra Help automatically. In 2027, that means generic drug copays of no more than $5.80 and brand-name copays of no more than $14.40, or $1.65 and $5.00 for full-benefit duals at or below 100% of the poverty level.
Where D-SNPs differ is coordination. One plan, and in an integrated D-SNP one company, handles both sides, which can mean fewer cards, one set of member services and help arranging Medicaid services such as personal care or home and community-based services. D-SNP PPOs also face federal limits on some out-of-network cost sharing starting in 2026.
Who is a D-SNP a good fit for?
A D-SNP usually fits people with full Medicaid who want Medicare and Medicaid to work as one.
- You already have a Heritage Health plan and want an integrated D-SNP from the same company.
- You use Medicaid services such as personal care, transportation or home and community-based services.
- You want care coordination built in.
- Your doctors and pharmacy are in the D-SNP's network.
Who might stay with regular Medicare Advantage or Original Medicare?
A regular plan, or Original Medicare with a drug plan, can still fit some dual eligibles.
- Your key doctors or hospital are in a regular plan's network but not in any D-SNP's.
- You have partial Medicaid help that a D-SNP in your county does not accept.
- You prefer Original Medicare's freedom to see any provider, with Medicaid paying second.
Our Medicare vs Medicaid comparison explains what each program covers, and Medicare Savings Programs in Nebraska covers the partial-help levels.
What mistakes do dual eligibles make choosing plans?
The most common mistake is switching plans because of a phone call or a mailer without checking doctors and medications. Monthly enrollment windows make it easy to switch, and easy to switch into the wrong plan.
Other mistakes:
- Not knowing your Medicaid level. Full Medicaid, QMB, SLMB and QI open different doors. Check with DHHS.
- Mismatching Medicare and Medicaid plans. If you want an integrated D-SNP, it generally needs to line up with your Heritage Health plan. Compare Nebraska's Heritage Health plans.
- Paying bills you don't owe. QMB members should show both cards at every visit.
- Missing renewal mail. Losing Medicaid can mean losing the D-SNP.
Who can help dual eligibles compare plans?
Medicare.gov's Plan Finder shows D-SNPs and regular plans in your ZIP code. Call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week (TTY 1-877-486-2048). Nebraska SHIP (formerly SHIIP) gives unbiased counseling at 1-800-234-7119, and the Heritage Health Enrollment Center (1-888-255-2605) helps with Medicaid plan choices. Medicaid applications go through DHHS at iServe Nebraska.
If you have Medicare and Medicaid and want your doctors and medications checked against each plan, talk to me. My help costs you nothing.
Frequently asked questions
You need Medicare Part A and Part B, you must live in the plan's service area, and you must also have Nebraska Medicaid. Each D-SNP decides which Medicaid levels it accepts, so some may take people with full Medicaid only while others may also accept people in certain Medicare Savings Programs. Ask the plan, and confirm your Medicaid status with DHHS before you enroll.
An integrated D-SNP combines your Medicare benefits with most or all of your Medicaid benefits through one company. In Nebraska, the three Heritage Health Medicaid companies, Molina, Nebraska Total Care through its Medicare partner Wellcare, and UnitedHealthcare, run highly integrated D-SNPs. A coordination-only D-SNP covers your Medicare benefits and coordinates with your separate Medicaid plan.
Often, yes. Since 2025, people with full Medicaid can use a monthly Special Enrollment Period to join or switch to an integrated D-SNP offered alongside their Medicaid plan. People with Medicaid or Extra Help can also switch standalone drug plans, or leave Medicare Advantage for Original Medicare with a drug plan, once a month. Changes take effect the first day of the next month.
It depends on your Medicaid level and the plan. If you have full Medicaid or the QMB program, Medicaid generally covers Medicare premiums and cost sharing, and Medicare providers are not allowed to bill QMB members for Medicare deductibles, coinsurance or copays. People with partial Medicaid help may pay some costs. Check each plan's details for your county.
D-SNPs are only for people with both Medicare and Medicaid, so losing Medicaid can mean losing eligibility for the plan. You get a Special Enrollment Period lasting 3 full months from when you lose eligibility or are notified, whichever is later, to choose other coverage. Respond to every DHHS renewal notice so you do not lose Medicaid by mistake.
No. Medicaid applications in Nebraska go through DHHS, using iServe Nebraska online or by calling (855) 632-7633. Once you have Medicare and Medicaid, a licensed agent can explain how a D-SNP or regular Medicare Advantage plan works with your Medicaid and help you compare your doctors and medications against each plan.
Sources
- Medicare.gov: Medicare & You 2027 (CMS Product No. 10050) (opens in a new tab)
- CMS: CY 2027 Medicare Advantage and Part D landscape files (opens in a new tab)
- CMS: Contract Year 2025 Medicare Advantage and Part D final rule fact sheet (CMS-4205-F) (opens in a new tab)
- Nebraska DHHS: Heritage Health external quality review report (opens in a new tab)
- Nebraska Department of Insurance: 2026 Special Needs Plan guide (opens in a new tab)
- Nebraska DHHS: iServe Nebraska and ACCESSNebraska (opens in a new tab)
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 to get information on all of your options. 1-800-MEDICARE (1-800-633-4227) is available 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048.
