CDISNM Blog
Major Medicare-Medicaid Plan Changes Coming in 2026
If you’re enrolled in an MMP plan, your coverage is changing — but you won’t lose it.
The Centers for Medicare & Medicaid Services (CMS) is phasing out Medicare-Medicaid Plans (MMPs) by the end of 2025. These were pilot programs under the Medicare Medicaid Program MMP model, designed to coordinate care for people eligible for both. Now they’re being replaced to improve care quality and simplify everything for you.
What’s Changing?
Medicare MMP plan users will see that their plans are ending. These were part of a pilot to help coordinate benefits across Medicare and Medicaid. Replacing them are D-SNPs (Dual Eligible Special Needs Plans) that combine Medicare and Medicaid benefits under new structures:
• FIDE SNPs: Both programs under one organization.
• HIDE SNPs: Coordinate closely, especially for long-term and behavioral health.
Timeline & What to Expect
Most MMP plan Medicare contracts will end by December 2025. States like California, Illinois, Michigan, Ohio, and South Carolina will automatically transition many people into a D-SNP with the same insurance company. You’ll get notices from your plan or state Medicaid office. Your benefits won’t disappear — but the plan name, ID card, and extras may change.
What You Might Gain
• One card for both Medicare and Medicaid.
• Easier billing and coordination.
• Better care management and support for chronic conditions.
• Some new D-SNPs offer extras like OTC credits, dental, vision, transport, and fitness.
Why This Matters
These changes aim to improve care and cut confusion. But you still need to read your plan notices and understand your new choices before 2026. Don’t wait — understand how your Medicare Medicaid Plans MMPs will change and what it means for your coverage.
We’re Here to Help
Call us today at 1-855-890-2583 for personalized assistance!
CDISNM Blog
What Does a Dual-Eligible Special Needs Plan (D-SNP) Cover?
If you qualify for Medicare and Medicaid, a dual eligible special needs plan may offer the extra support and savings you need.
What is a D-SNP?
A D-SNP is a type of Medicare Advantage plan created specifically for people who have both Medicare and Medicaid. These plans coordinate your care, provide enhanced support, and tailor benefits for those who often face greater health or financial challenges.
Because D-SNPs bring both programs together under one umbrella, they’re sometimes called dual advantage plans or dual special needs plans. The goal is to make managing your healthcare simpler and more affordable.
What D-SNPs Typically Cover
• Full Medicare benefits (Parts A & B): Hospital stays, doctor visits, preventive services, skilled nursing, lab work, and durable medical equipment — just like other Medicare Advantage plans.
• Prescription drug coverage (Part D): D-SNPs include built-in Part D, often with no or minimal copays depending on your Medicaid level. Many also offer a broader drug list than standard Part D plans.
• Medicaid benefits (state-based): May include long-term care, personal support, transportation to medical visits, and home or community services — based on your state’s Medicaid rules.
• Routine extras: Many plans add dental cleanings, vision exams, hearing aids, and over-the-counter (OTC) allowances for items such as vitamins or pain relievers.
Care Coordination Makes a Difference
Many D-SNPs include a dedicated care coordinator or case manager who can reduce hospital stays and eliminate confusion. They can help explain how to use your benefits, schedule doctor visits and follow-ups, manage chronic conditions, and connect your Medicare and Medicaid services so nothing gets missed.
Why D-SNPs Matter
Navigating two government programs can be overwhelming. A D-SNP brings them together under one card and one team, simplifying life. If you’re eligible, you could enjoy stronger coverage, lower costs, and more confidence in your care.
We’re Here to Help
Call 1-855-890-2583 to connect with an Education Specialist about available D-SNPs in your area and find the right plan for your needs.
CDISNM Blog
Understanding Medicare Enrollment Penalties
Missing a deadline could cost you — permanently.
Medicare has a few important enrollment periods. Miss one, and you might pay more every month for life. The good news? You can avoid these Medicare enrollment penalties if you know how the rules work.
Medicare Part B Late Enrollment Penalty
What is it? If you don’t enroll in Medicare Part B (medical insurance) when you’re first eligible and don’t have other creditable coverage, you’ll face a monthly penalty. This is one of the most common reasons people end up paying more.
How much is it? 10% of the standard Part B premium for each full 12-month period you went without coverage. This penalty lasts for life.
• Example: Delay Part B by 2 years → 20% added to your premium permanently. That’s a serious penalty for not signing up at age 65.
• How to avoid it: Enroll during your Initial Enrollment Period (IEP) — a 7-month window around your 65th birthday. Or delay safely if you have active job-based coverage. Once that ends, you get an 8-month Special Enrollment Period (SEP) to avoid a penalty for signing up late.
Medicare Part D Late Enrollment Penalty
What is it? If you go more than 63 days without creditable drug coverage after you’re first eligible, you’ll pay a Medicare drug plan penalty when you finally sign up.
How much is it? 1% of the national base premium (about $34.70 in 2024), multiplied by the number of months you went without coverage. This penalty is added to your monthly premium — for life.
• Example: 10 months without drug coverage → 10% of $34.70 = $3.47/month, permanently.
• How to avoid it: Sign up for Part D during your IEP or keep other creditable drug coverage (like VA, Tricare, or employer plans). If you lose that coverage, you usually have 63 days to avoid the penalty.
Why This Matters
Penalties may seem small monthly but add up over time — and they last as long as you have Medicare. The key to avoiding them is simply knowing your deadlines so you don’t pay more than necessary for your coverage.
We’re Here to Help
Call 1-855-890-2583 to talk with an Education Specialist about avoiding Medicare enrollment penalties.
CDISNM Blog
When Can You Change Your Medicare Supplement Plan?
Apply to switch Medigap coverage any time — but timing affects your options.
You can technically apply to switch at any point. However, changing your Medicare Supplement plan might involve more scrutiny. Insurers could deny coverage based on your health history, charge higher premiums for pre-existing conditions, or impose waiting periods.
When You Have Guaranteed Issue Rights
There are special cases — usually within 63 days — when insurers must accept your application:
• You’re in your Medigap Open Enrollment Period (first 6 months of Part B at 65).
• Your Medicare Advantage plan is ending, leaving your area, or you’re moving back to Original Medicare.
• You’ve lost other coverage, like a retiree or employer plan.
• Your Medigap company misled you or went bankrupt.
Steps To Safely Switch Plans
1. Apply for the new plan first — don’t cancel your current one until approved.
2. Wait for confirmation, then set your start date.
3. Cancel your old plan in writing to avoid double bills.
When To Consider Switching
• You want lower premiums.
• You’re paying for extras you don’t use.
• You moved to a state with different plan costs.
• Your health or finances have changed.
Why It Matters
Whether you’re wondering “how do I change my Medicare Supplement plan?,” “can you change your Medicare Supplement plan?,” or “can you switch Medicare Supplement plans easily?,” the answer is yes — but with caution. Approval isn’t guaranteed unless you’re in a protected switch.
CDISNM Blog
Understanding Your Core Medicare Coverage
Understand the foundational parts of Medicare:
Medicare Part A (Hospital Insurance): This covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Keep in mind that Part A has a deductible, and after 60 continuous days in the hospital, copays may apply.
Medicare Part B (Medical Insurance): This covers a range of outpatient medical services, including doctor visits, preventative care (like annual wellness exams), and durable medical equipment. Typically, Original Medicare (Part A and Part B combined) covers about 80% of these services.
Exploring Your Plan Options
Now, let’s explore your plan options to help cover the remaining costs:
Medicare Supplement Insurance (Medigap): Helps pay for out-of-pocket costs not covered by Original Medicare, such as the Part A deductible and Part B coinsurance (the 20% you’d typically pay).
Additional Coverage: Some Medigap plans also cover excess charges under Part B.
Monthly Premiums: These plans typically have a monthly premium.
Medicare Part D (Prescription Drug Plan): If you choose a Medigap plan, you’ll typically need to enroll separately in a Medicare Part D plan for outpatient medications.
Nationwide Freedom: Medigap plans let you see any doctor or hospital nationwide that accepts Medicare.
Medicare Advantage (MA) Plans (Part C): An “all-in-one” alternative to Original Medicare that bundles Part A, Part B, and usually Part D.
Private Insurance: Offered by private insurance companies that contract with Medicare.
Network-Based: Often limited to providers within a network (like HMO or PPO).
Premiums and Cost-Sharing: May have lower premiums but include copays and deductibles for services received throughout the year.
Extra Benefits: Often include vision, dental, hearing, and other benefits not covered by Original Medicare.
Medicare Part D: Most MA plans include drug coverage in one convenient plan.
Finding the Right Fit for You
Choosing the Medicare plan option that best suits your individual healthcare needs and budget is an important decision. Talk to a licensed agent who can guide you through each option and help you make an informed choice.
Special Enrollment Period (SEP)
Experienced a life-changing event (e.g., losing employer coverage, moving, or changes in Medicaid eligibility)? You may qualify for a SEP to enroll outside the standard windows.
We’re Here to Help
Call us today at 1-855-890-2583 for personalized assistance!
