In short
- To join a D-SNP you need Medicare Part A and Part B plus Nebraska Medicaid, and you must live in the plan's service area. Each plan decides which Medicaid categories it accepts.
- Nebraska had 43,941 people with both Medicare and Medicaid in June 2026, according to CMS enrollment data.
- For 2027, UnitedHealthcare, Wellcare, Molina, Aetna, Humana and Devoted Health offer D-SNPs in parts of Nebraska. Availability varies by county and changes every year.
- Since 2025, people with Medicaid or Extra Help can switch standalone drug plans once a month, and people with full Medicaid can join an integrated D-SNP once a month.
- Starting with 2027 plans, a company that also runs a Heritage Health plan may limit new enrollment in its D-SNP to members of its own Medicaid plan. Confirm with the plan before you switch.
If you have both Medicare and Nebraska Medicaid, you're what Medicare calls "dual eligible," and you have plan choices most people don't. A Dual Eligible Special Needs Plan is built for exactly that situation. Here's who qualifies, how these plans fit with Heritage Health, which companies offer them in Nebraska for 2027, and the rule changes that matter this year.
Who qualifies for a D-SNP in Nebraska?
You can join a D-SNP if you have Medicare Part A and Part B, you have Nebraska Medicaid, and you live in the plan's service area. Medicaid comes in different levels, and each D-SNP decides which ones it accepts.
- Full Medicaid covers health care services on top of Medicare, often through a Heritage Health plan.
- Medicare Savings Programs (QMB, SLMB and QI) help pay Medicare costs like the Part B premium. Some D-SNPs accept people who have only a Medicare Savings Program, and some require full Medicaid. The plan's materials spell it out.
Here are Nebraska's 2026 monthly income limits from DHHS. The 2027 limits follow the federal poverty guidelines, which usually come out in January.
| Program (2026) | Monthly income, individual | Monthly income, couple | Resource limit, individual / couple |
|---|---|---|---|
| Aged, blind and disabled Medicaid | $1,330 | $1,804 | $4,000 / $6,000 |
| QMB (pays Part A and Part B premiums, deductibles and coinsurance) | $1,330 | $1,804 | $9,950 / $14,910 |
| SLMB (pays the Part B premium) | $1,596 | $2,164 | $9,950 / $14,910 |
| QI (pays the Part B premium) | $1,796 | $2,435 | $9,950 / $14,910 |
DHHS decides who qualifies, using its own counting rules, so treat this table as a starting point. Nebraska had 43,941 people with both Medicare and Medicaid in June 2026, according to CMS. My page on Medicare Savings Programs in Nebraska goes deeper, and Medicare vs Medicaid explains how the two programs differ.
How does a D-SNP work with Nebraska Medicaid?
A D-SNP is a Medicare Advantage plan that contracts with the state Medicaid program to coordinate your Medicare and Medicaid benefits. It covers your Medicare hospital and medical care, includes Part D drug coverage, and adds care coordination. Medicare pays first, and Medicaid may cover some or all of your Medicare cost sharing, depending on your Medicaid level.
Nebraska Medicaid runs through Heritage Health, with three managed care companies: Molina Healthcare of Nebraska, Nebraska Total Care and UnitedHealthcare Community Plan. Molina replaced Healthy Blue when new contracts started January 1, 2024. Nebraska DHHS says each of the three runs a highly integrated D-SNP.
D-SNPs come in levels of integration, defined in federal rules:
| Type | How it works with Medicaid |
|---|---|
| Highly integrated (HIDE) | The company, or its parent, also holds a Medicaid managed care contract with the state and covers certain Medicaid benefits under it |
| Coordination-only | Coordinates your Medicare and Medicaid care but doesn't cover Medicaid benefits itself; your Medicaid stays with your separate plan |
| Fully integrated (FIDE) | One company covers both Medicare and Medicaid under a single arrangement |
In the CMS 2027 landscape, Nebraska's D-SNPs are listed as either highly integrated or coordination-only.
One protection to know about: if you're in the QMB program, Medicare providers aren't allowed to bill you for Medicare Part A and Part B deductibles, coinsurance or copays. In some cases you may owe a small Medicaid copay instead. If you get a bill for Medicare cost sharing, tell the provider you're in QMB and show your Medicare and Medicaid cards.
Which companies offer D-SNPs in Nebraska for 2027?
Six companies have D-SNPs in parts of Nebraska for 2027, according to the CMS landscape files. These are market-level facts about where plans are offered. Plan availability, premiums, networks and benefits vary by county and change every year.
| Company | Integration level | 2027 footprint and changes |
|---|---|---|
| UnitedHealthcare | Highly integrated, plus a new coordination-only plan | A PPO in 77 counties, an HMO-POS in 75 counties (including Lancaster and Hall), and an HMO-POS in 9 counties (including Douglas and Sarpy). A new coordination-only HMO-POS covers 84 counties. Two 2026 plans are discontinued. |
| Wellcare (Centene, partner to Nebraska Total Care) | Highly integrated | One HMO-POS in 66 counties, renamed Wellcare Nebraska Total Care Dual Liberty Sync (HMO-POS D-SNP). Its PPO D-SNP is discontinued. |
| Molina | Highly integrated | An HMO in 56 counties, moving to a new contract under Molina Healthcare of Nebraska |
| Aetna | Coordination-only | 54 counties, now including Hall |
| Humana | Coordination-only | 26 counties |
| Devoted Health | Coordination-only | Grows from 14 counties to 42, including Lancaster |
If your 2026 plan is one of the discontinued ones, your plan has to send you a notice, and you'll need to choose new coverage. Read your Annual Notice of Change either way.
Nebraska also has other special needs plans: chronic condition plans from Devoted in 42 counties, institutional plans from Great Plains, and a new institutional plan, Nebraska Health Advantage, in Antelope, Burt, Cedar and Nance counties. For a company-level look, see D-SNP plans in Nebraska, and for how these differ from regular plans, D-SNP vs Medicare Advantage.
What changed for D-SNP enrollment since 2025?
Two sets of federal changes reshaped how dual eligibles enroll.
Starting in 2025: monthly changes, with limits. The old quarterly Special Enrollment Period for people with Medicaid or Extra Help was replaced with two monthly options:
- Once a month, you can join or switch standalone Part D plans, or leave Medicare Advantage for Original Medicare with a standalone drug plan.
- If you have full Medicaid, once a month you can join or switch to an integrated D-SNP offered by the same company as your Medicaid plan.
Changes start the first day of the next month. What you can't do any month is hop from one regular Medicare Advantage plan to another. That waits for Annual Enrollment, October 15 to December 7, or another Special Enrollment Period. People flagged as at-risk under a plan's drug management program can't use the monthly drug plan option.
Starting in 2027: D-SNPs tied to Medicaid plans. Under 42 CFR 422.514(h), when a company offers a D-SNP and also has a Medicaid managed care contract in the same area, it may generally offer only one D-SNP for full-benefit dual eligibles there, and it must limit new enrollment to people enrolled in, or enrolling in, its own Medicaid plan. Beginning in 2030, those D-SNPs may only enroll or keep members who are in the company's Medicaid plan.
In Nebraska, UnitedHealthcare, Molina and Centene's Wellcare are each tied to a Heritage Health plan, so this rule can affect which of their D-SNPs you're able to join. How each company applies it for 2027 isn't spelled out in the public plan data, so if you have full Medicaid and want one of those D-SNPs, ask the plan whether you also need its Heritage Health plan before you switch. The Heritage Health Enrollment Center at 1-888-255-2605 handles Medicaid plan changes and can tell you when you're allowed to switch.
How do you apply for Medicaid or a Medicare Savings Program?
Through Nebraska DHHS. Apply online at iServe Nebraska, or call DHHS at (855) 632-7633 toll-free, (402) 473-7000 in Lincoln or (402) 595-1178 in Omaha. I don't enroll anyone in Medicaid, and DHHS makes every eligibility decision.
Once you're approved, a few things follow. People with full Medicaid or a Medicare Savings Program qualify for Extra Help automatically, and Medicare mails a purple letter confirming it. QMB coverage starts the first of the month after DHHS processes your eligibility, with no retroactive coverage. QI can cover up to 3 months back within the same calendar year. See Extra Help for how drug costs change.
What does a D-SNP member pay?
It depends on your Medicaid level and the plan, so I won't quote any plan's costs here. The federal limits on drug costs give a sense of the range for 2027:
| Who | Most you pay per covered prescription in 2027 |
|---|---|
| Full Medicaid with income at or below 100% of the poverty level | $1.65 generic, $5.00 other drugs |
| Other people with Extra Help | $5.80 generic, $14.40 brand-name |
| Anyone after reaching the $2,400 Part D cap | Nothing more for covered drugs that year |
If you have QMB, SLMB or QI, the state pays your Part B premium ($202.90 a month in 2026). Your plan's Summary of Benefits shows its own copays.
Do Nebraska's Medicaid work requirements affect you?
Probably not directly. Nebraska's work requirements took effect May 1, 2026, for Heritage Health Adult members ages 19 to 64, the Medicaid expansion group. People with Medicare don't qualify for coverage through that group. What does affect everyone is renewal. Watch for every DHHS letter and answer by the deadline, because losing Medicaid also ends your D-SNP eligibility. More in Nebraska Medicaid work requirements.
How do I help people with Medicare and Medicaid?
I start the same way I do with everyone: medications and doctors. Then we check that your doctors take both your Medicare plan and your Medicaid, look at which Heritage Health plan you're in, and compare the D-SNPs, regular Medicare Advantage plans and Original Medicare with a Part D plan available in your county. For Medicaid questions, I point you to DHHS. For Medicare plan enrollment, I can help, and you make the decision.
Where can you get unbiased help?
Nebraska SHIP (formerly SHIIP), part of the Nebraska Department of Insurance, counsels people with Medicare and Medicaid at 1-800-234-7119. 1-800-MEDICARE (1-800-633-4227) is available 24 hours a day, 7 days a week (TTY 1-877-486-2048). For Medicaid itself, contact Nebraska DHHS, and for Medicaid plan choices, the Heritage Health Enrollment Center. To compare Heritage Health plans, see Medicaid plans in Nebraska.
When you're ready to look at Medicare plans that work with your Medicaid, talk to me. My help costs you nothing.
Frequently asked questions
No. A D-SNP is one option. You can also keep Original Medicare with Nebraska Medicaid and a standalone Part D plan, or join a regular Medicare Advantage plan. People with Medicaid automatically qualify for Extra Help with drug costs whichever way they go. The right choice depends on your doctors, your medications and how much coordination help you want.
Sometimes. If you have full Medicaid, you can join or switch to an integrated D-SNP that matches your Medicaid plan once a month, starting the first of the next month. People with Medicaid or Extra Help can also switch standalone drug plans once a month. Switching from one regular Medicare Advantage plan to another generally waits for the fall Annual Enrollment Period or another Special Enrollment Period.
Your plan will contact you, because you need Medicaid to stay in a D-SNP. You get a Special Enrollment Period lasting 3 full months from the date you're no longer eligible or are notified, whichever is later, to choose other Medicare coverage. The faster step is often to keep your Medicaid renewal current, so read every letter from Nebraska DHHS and respond by its deadline.
No. Nebraska Medicaid and Medicare Savings Program applications go through Nebraska DHHS, online at iServe Nebraska or by calling (855) 632-7633. DHHS decides who qualifies. A licensed Medicare agent can explain how Medicaid and Medicare work together, and once you have Medicaid, help you compare and enroll in Medicare plans, including D-SNPs available in your county.
A highly integrated D-SNP, or HIDE, is offered by a company that also holds a Medicaid managed care contract with the state, and it covers certain Medicaid benefits under that contract. A coordination-only D-SNP helps coordinate your Medicare and Medicaid but doesn't cover Medicaid benefits itself, so your Medicaid comes through your separate Heritage Health plan. In Nebraska, the three Heritage Health companies run HIDE plans.
Nebraska's work requirements, which took effect May 1, 2026, apply to Heritage Health Adult members ages 19 to 64. That's the Medicaid expansion group, and people with Medicare don't qualify for coverage through it. People with Medicare who get Medicaid through other categories, like aged, blind and disabled Medicaid, still need to keep up with their regular renewals.
Sources
- Medicare.gov: Medicare & You 2027 (Special Needs Plans) (opens in a new tab)
- eCFR: 42 CFR 422.514(h), D-SNPs and Medicaid managed care (opens in a new tab)
- eCFR: 42 CFR 422.2, definitions of integrated D-SNPs (opens in a new tab)
- CMS: Contract Year 2025 Medicare Advantage and Part D final rule fact sheet (opens in a new tab)
- CMS: CY 2027 Medicare Advantage and Part D landscape files (September 2026) (opens in a new tab)
- Nebraska DHHS: Income levels, FPL and resources (477-000-012, rev. May 8, 2026) (opens in a new tab)
- Nebraska DHHS: iServe Nebraska and ACCESSNebraska (opens in a new tab)
- Nebraska DHHS: Medicaid work requirements (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.
