How a D-SNP works
- It's a Medicare Advantage plan. A private company approved by Medicare provides your Part A and Part B coverage, and every special needs plan must include Part D.
- It's only for dual eligibles. You need Medicare Part A and Part B, Medicaid, and you must live in the plan's service area. A D-SNP can limit which Medicaid levels it accepts, so ask the plan.
- It coordinates with Medicaid. Federal rules require every D-SNP to have a contract with the state Medicaid agency (42 CFR 422.107). In Oregon, CCOs also sign agreements with the Medicare Advantage plans, including D-SNPs, that serve their members, so Medicare and OHP benefits line up.
- It may have a network. Check that your doctors, hospital and pharmacy are in it before you join.
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.
D-SNPs in Oregon
OHA requires each CCO to work with Medicare Advantage plans that serve full-benefit dual eligible members throughout its service area,. In practice, the D-SNP you can join depends on where you live.
CMS's 2027 plan data lists 26 special needs plans across Oregon, counting every type (dual, chronic condition and institutional), not only D-SNPs. Choice is thin in rural Oregon: for 2027 there is no Medicare Advantage plan open to everyone in Grant, Harney, Lake, Umatilla and Union counties, and Curry County has only a special needs plan. See your county on Medicare by Oregon county.
How to decide
- Confirm your OHP level. Your ODHS notice says whether you have full OHP, QMB or another program.
- List your doctors and drugs. Check each D-SNP's network and drug list.
- Ask your CCO. Find out which Medicare plans it works with in your county.
- Compare with Original Medicare. With OHP and Original Medicare, you can see any provider that accepts Medicare and add a Part D plan.
To see D-SNPs for your ZIP code, compare plans on PlanMatch, or request a call from a licensed insurance agent to go over plans from the companies they work with. More in dual eligibility in Oregon.
Related questions
Do I keep my CCO with Medicare?
Your CCO stays the same.
Can I have Medicare and OHP?
How the two work together.
Is Medicare Advantage in every Oregon county?
Where plans aren't offered.
Sources
- Medicare.gov — Special Needs Plans (SNP)
- Oregon Health Authority — OHP and Medicare
- Oregon Health Authority — Guidance on Medicare plan to CCO affiliation (2025)
- eCFR — 42 CFR 422.107, special needs plans and dual eligibles: contract with state Medicaid agency
- CMS — Medicare Advantage and Part D contract and enrollment data (CY2027 Landscape file)
More questions in this guide
- Can I have Medicare and the Oregon Health Plan?
- Do I keep my CCO when I get Medicare in Oregon?
- Does OHP pay my Medicare Part B premium?
- How do I qualify for Medicaid long-term care in Oregon?
- What's the difference between Medicare and Medicaid in Oregon?
- What happens to my OHP when I turn 65?
- What is Oregon Project Independence and who qualifies?
Part of the guide: Oregon Health Plan and Medicare: combined coverage · All questions
Frequently asked questions
Do I lose OHP if I join a D-SNP?
No. The D-SNP is your Medicare coverage and OHP stays your Medicaid coverage. OHA says D-SNPs work closely with your OHP benefits.
Do I have to join a D-SNP if I have Medicare and OHP?
No. You can keep Original Medicare with a Part D plan, choose another Medicare Advantage plan, or join a D-SNP where one is offered.
What happens if I lose OHP while in a D-SNP?
Medicare.gov says you can stay in a special needs plan only while you meet its conditions. If you lose eligibility, you may get a special enrollment period to join another plan.
Can I change plans more often because I have OHP?
Medicare.gov says people with Medicaid or Extra Help may be able to change drug coverage once a month. Call 1-800-MEDICARE to confirm what you can do.
Medicare in your Oregon county
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