What is a D-SNP?
A dual eligible special needs plan (D-SNP) is a type of Medicare Advantage plan limited to people who have Medicare and Medicaid. It covers Part A, Part B and Part D services and must have a contract with the state Medicaid agency, in Florida the Agency for Health Care Administration (AHCA) (42 CFR 422.107). Federal rules (42 CFR 422.2) and AHCA's D-SNP contract set three levels:
| Type | What it covers in Florida | Plans in 2027 |
|---|---|---|
| FIDE SNP (fully integrated) | Medicare and Medicaid through one company that also holds a Florida Medicaid managed care contract, including Medicaid long-term care, behavioral health, home health, medical equipment and Medicare cost sharing | 3 plans in 42 counties |
| HIDE SNP (highly integrated) | Medicare plus some Medicaid benefits under a capitated contract with AHCA, including behavioral health, Medicare cost sharing, home health and medical equipment | 60 plans in all 67 counties |
| Coordination-only | Medicare; coordinates with Medicaid, which pays separately. Florida lets these plans enroll only partial-benefit dual eligibles | 64 plans in 66 counties |
Source: CMS CY2027 Landscape file (November 2026 release) and AHCA's D-SNP contract, Attachment I-B.
Florida's D-SNP picture for 2027
- Everywhere, but uneven. D-SNPs are sold in all 67 counties. By county, from 1 plan in Monroe County to 35 in Hillsborough, Orange, Osceola, Polk and Seminole counties. Counting all special needs plans (dual, chronic-condition and institutional), CMS lists 245 statewide, from 1 in Monroe to 72 in Hillsborough.
- Fewer plans, more coordination-only. Florida had 155 D-SNPs in 2026 (2 FIDE, 117 HIDE, 36 coordination-only). For 2027 the total fell to 127, and many former HIDE plans are now coordination-only.
- FIDE counties. The three FIDE SNPs together reach 42 counties, including Miami-Dade, Broward, Palm Beach, Hillsborough, Pinellas, Orange, Duval and Sumter. Your ZIP code decides which plans you can join.
- Full Medicaid vs. partial help matters. With full Medicaid you can join a FIDE or HIDE plan whose rules include you, but not a coordination-only plan. With only QMB, SLMB, QI or QDWI, coordination-only plans are open to you if they accept your group.
Whether a plan is ending for 2027 is on plans ending in 2027; if yours is, you'll get a non-renewal letter and a special enrollment period.
Your Medicaid side
- Full Medicaid: Florida puts most full-Medicaid members, including people with Medicare, in a Statewide Medicaid Managed Care (SMMC) plan (s. 409.965, s. 409.972). A FIDE SNP enrolls only people whose Medicaid plan is from the same company (exclusively aligned enrollment, 42 CFR 422.2). If you need long-term care, it comes through the SMMC Long-Term Care program; see Florida Medicaid long-term care.
- Medicare Savings Program only: your Medicaid pays Medicare premiums and, with QMB, Medicare cost sharing. There's no SMMC plan to join. See Medicare Savings Programs in Florida.
When you can join or switch
- Open Enrollment, October 15 to December 7. Anyone with Medicare can change plans for January 1. Open Enrollment for 2027 is under way now.
- Monthly Part D period. People with Medicaid or Extra Help can switch to a standalone Part D plan once per month, which also returns them to Original Medicare (42 CFR 423.38(c)(4)).
- Monthly integrated-plan period. Full-benefit dual eligibles can join a FIDE SNP, HIDE SNP or applicable integrated plan once per month, but only to line up with the company that provides their Medicaid (423.38(c)(35)).
- When your Medicaid changes. Gaining, losing or changing Medicaid or Extra Help gives you a special enrollment period.
- If you lose Medicaid. If your D-SNP expects you to regain Medicaid within 6 months, for example after a late renewal, it must keep you for at least 30 days and up to 6 months before ending your coverage (42 CFR 422.52(d)).
Changes generally start the first day of the next month.
Before you join a D-SNP
- Confirm your Medicaid category (full Medicaid, QMB, SLMB or QI) on your DCF notice or by calling DCF at (850) 300-4323.
- Check that your doctors, hospitals and pharmacies are in the plan's network and also accept Florida Medicaid, and check your drugs on the plan's formulary.
- Keep your Medicaid renewal current with DCF: losing Medicaid can end your D-SNP eligibility.
- If you have QMB, providers may not bill you for Medicare cost sharing, whichever Medicare option you choose.
Medicare Advantage plans may offer extra benefits such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
Compare setups side by side: D-SNP vs. Original Medicare and Florida Medicaid. To see plans for your ZIP code, use PlanMatch, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048), or request a call from a licensed insurance agent to review D-SNPs from the companies they work with.
Sources
- AHCA — Medicare Advantage Dual Eligible Special Needs Plan contract, Attachment I-B
- CMS — Medicare Advantage Landscape files, contract years 2026 and 2027 (D-SNP integration status, counties)
- Medicare.gov — Special Needs Plans (SNP)
- eCFR — 42 CFR 422.2, definitions (FIDE SNP, HIDE SNP, exclusively aligned enrollment)
- eCFR — 42 CFR 422.107, D-SNP contracts with state Medicaid agencies
- eCFR — 42 CFR 422.52, special needs plan eligibility (deemed continued eligibility)
- eCFR — 42 CFR 423.38, enrollment periods
- AHCA — Statewide Medicaid Managed Care
- Fla. Stat. 409.972, Mandatory and voluntary enrollment
- Florida DCF — Public Assistance (ACCESS Florida)
- CMS — Qualified Medicare Beneficiary program
Frequently asked questions
Can I join a D-SNP in Florida if I have only QMB or SLMB?
Yes, if a plan in your area accepts your group. Coordination-only D-SNPs in Florida may enroll only partial-benefit dual eligibles (QMB, SLMB, QI or QDWI), and each plan's contract lists which of those groups it takes. Check the plan's eligibility rules before you apply.
How is a FIDE SNP different from other D-SNPs in Florida?
A FIDE SNP is run by a company that holds both the Medicare contract and a Florida Medicaid managed care contract, and since 2025 it enrolls only people who get their Medicaid from that same company. It covers Medicare and Medicaid benefits together, including Medicaid long-term care.
What is the dual special enrollment period?
If you have Medicaid or Extra Help, you can switch to a standalone Part D plan once per month, which also returns you to Original Medicare if you were in a Medicare Advantage plan (42 CFR 423.38(c)(4)). Full-benefit dual eligibles can also join an integrated D-SNP once per month to line it up with their Medicaid plan (423.38(c)(35)).
How many D-SNPs are in Florida for 2027?
127 D-SNPs from 14 parent companies, sold in all 67 counties, according to CMS's 2027 Landscape file. That's down from 155 in 2026. By county the number ranges from 1 in Monroe County to 35 in Hillsborough, Orange, Osceola, Polk and Seminole counties.
Medicare in your Florida county
Plans, local agents and help, county by county: Miami-Dade · Broward · Palm Beach · Hillsborough · Orange · Duval · Pinellas · Lee · Polk · Pasco · Brevard · Volusia · Seminole · Sarasota · Osceola · Manatee · Lake · Marion · Collier · St. Lucie · All 67 counties →
