What is a D-SNP, and does it include rides?
A dual special needs plan, or D-SNP, is a Medicare Advantage plan limited to people enrolled in both Medicare and Medicaid. It must contract with the state Medicaid agency and coordinate the two programs. A D-SNP may offer rides as a supplemental benefit, which can be limited to a set number of trips. For full-benefit members, Medicaid's ride benefit still sits behind it.
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What makes a plan a D-SNP
Federal rules define a D-SNP in 42 CFR 422.2. It is a specialized Medicare Advantage plan for people who also have Medicaid. It must coordinate Medicare and Medicaid services, it may cover some Medicaid services itself, and it must hold a contract with the state Medicaid agency. Since January 1, 2021, every D-SNP also has to meet at least one integration standard.
That produces three kinds of plan, which CMS tracks separately:
| Type | What it means | Plans, September 2026 | Enrollment, September 2026 |
|---|---|---|---|
| Coordination-only (CO) | Neither HIDE nor FIDE. Its state contract must have it notify the state of hospital and skilled nursing facility admissions for a high-risk group of members | 667 | 3,373,778 |
| Highly integrated (HIDE) | Holds a capitated Medicaid contract covering long-term services and supports or behavioral health | 314 | 2,312,469 |
| Fully integrated (FIDE) | One company holds both the Medicare and the Medicaid managed care contract, with only aligned members | 101 | 799,814 |
| All D-SNPs | 1,082 | 6,486,061 |
The counts come from CMS’s Special Needs Plan Comprehensive Report for September 2026, which leaves out employer-only group plans. CMS also flags plans that enroll only partial duals, people whose Medicaid pays Medicare costs but gives no full Medicaid benefits. See dual eligible for those categories.
Do D-SNPs cover rides
Not automatically. Original Medicare pays for non-emergency transport only by ambulance, under strict medical rules. CMS’s Medicare Managed Care Manual says a Medicare Advantage plan has no duty to provide transportation to routine Part A and Part B services, but it may offer rides as a supplemental benefit. Those rides must serve the member’s health care needs only, must be arranged or provided by the plan, and must be described in the plan’s benefit package.
D-SNPs usually pay for supplemental benefits with rebate dollars, a share of the amount by which the benchmark for the plan’s service area exceeds its bid. Each plan describes its own supplemental benefits in its benefit package, so ride benefits differ from plan to plan. The guide to Medicare Advantage transportation work covers how providers join those networks.
How plan rides sit beside Medicaid NEMT
Medicare pays first whenever both programs cover the same thing, and supplemental benefits count. CMS’s coordination FAQs spell out what that means for rides:
- Medicaid through fee-for-service. The D-SNP can still offer rides. The state can require members to use up the plan’s trips before Medicaid transportation pays.
- Medicaid through a capitated plan. The same company cannot be paid twice for the same trips. A plan with both contracts can combine the two funding streams into one benefit, as long as it can separate out the Medicaid share for rate setting.
- Medicaid rides through a capitated state vendor. The state and its vendor must coordinate so Medicaid does not pay for trips the D-SNP covers.
Integration does not always pull Medicaid rides into the plan. New York’s Medicaid Advantage Plus plans, which require both Medicare and Medicaid, stopped covering NEMT on March 1, 2024. The state broker arranges those rides now.
One rider, several payers
For example, a D-SNP member’s dialysis rides might come from the plan until its trip allowance runs out, then from Medicaid. HealthRide prices each trip from the right payer’s rates and builds invoices per payer from the trips you actually ran. See invoicing.
Frequently asked questions
- Does joining a D-SNP end a member's Medicaid?
- No. The member keeps Medicaid and gets Medicare benefits through the plan. Depending on the state contract, the plan may also cover some Medicaid services, or those services may stay with the state or a separate Medicaid plan. Transportation follows the same split: plan rides on one side, Medicaid NEMT on the other.
- Can a member use both D-SNP rides and Medicaid rides?
- Yes, and Medicare pays first. CMS guidance says a state can require dual eligible members to use up the trips their D-SNP provides before the Medicaid transportation benefit pays. States can also write coordination duties, such as sharing benefit and usage information, into their contracts with D-SNPs.
- What is the difference between a FIDE SNP and a HIDE SNP?
- A FIDE SNP runs Medicare and Medicaid benefits through one company that holds both contracts, including long-term care, behavioral health, and home health, and it enrolls only members whose Medicaid is with that company. A HIDE SNP needs a capitated Medicaid contract, held by the plan's company or an affiliate, that covers long-term services and supports or behavioral health.
- How does a transportation company get D-SNP trips?
- Through the plan. Medicare Advantage rules say a supplemental ride benefit must be arranged or directly provided by the plan, so the way in is the plan's own network or the transportation vendor it hires. Each plan describes its ride benefit, including any limits, in its benefit package.
