D-SNP Medicare plans and Medicaid in Texas

A Dual Eligible Special Needs Plan (D-SNP) is a type of Medicare Advantage plan for people who meet the plan’s Medicare and Medicaid eligibility requirements. Having Medicare, living in Texas, or receiving a benefits advertisement does not establish eligibility. RGI Group is an independent Texas insurance agency offering English and Spanish guidance by phone or virtual consultation, not a government eligibility office.

Who can join a D-SNP?

You must have Medicare Part A and Part B, live in the plan’s service area, and meet that D-SNP’s Medicaid eligibility criteria. Some plans accept particular Medicaid categories, so partial assistance with Medicare costs and full Medicaid are not interchangeable for every plan. Confirm your current category with Texas Health and Human Services and the plan before applying.

Medicare and Texas Medicaid have different jobs

Medicare covers eligible health services under federal rules. Medicaid assistance depends on Texas eligibility rules and your category; it may help with Medicare costs or other services. D-SNPs coordinate these coverages through agreements with the state, but the level of integration varies. Joining a D-SNP does not grant Medicaid, replace a state eligibility decision, or guarantee extra benefits.

Compare your own county and care route

Start with your permanent address and county, then verify the current plan service area. In Houston, Dallas, San Antonio, Austin and McAllen, a city name alone cannot confirm eligibility or network participation. Check each primary care doctor, specialist, hospital and pharmacy you use, including any outside your home county; do not rely on a neighbor’s plan or an advertisement.

Prescription coverage and Extra Help

Special Needs Plans include Part D prescription drug coverage. Compare the current formulary, drug tier, prior authorization, quantity limits and pharmacy status for each prescription. Extra Help is assistance with Medicare drug costs, not the same thing as full Medicaid or automatic eligibility for every D-SNP. Confirm your assistance status using official Medicare and state resources.

Enrollment timing is not automatic

For 2027 coverage, the Annual Enrollment Period runs October 15 through December 7, 2026, with changes generally effective January 1, 2027. The usual Initial Enrollment Period around turning 65 is separate. People with Medicaid or Extra Help may have Special Enrollment Period rights, but permitted changes, qualifying categories and timing depend on the specific rule. Do not assume that any D-SNP can be joined or changed at any time.

If Medicaid eligibility changes

Read notices from Texas Health and Human Services and your plan promptly. A change in eligibility may affect D-SNP enrollment and any continuation period; rules differ by plan and circumstances. Ask the plan and Medicare about your options and effective dates before canceling coverage. RGI Group cannot decide Medicaid eligibility or promise that coverage will continue.

Prepare privately for a no-cost consultation

Keep your eligibility notices and provider and prescription lists available for a private discussion; do not upload Medicare IDs, Social Security numbers, medical history or prescriptions to this website’s request forms. There is no charge for the consultation and no obligation to enroll. A contact request does not enroll you, establish eligibility, or complete Medicare permission-to-contact or scope-of-appointment requirements.

Questions to ask before choosing a plan

Which Texas Medicaid category do I have, and does this D-SNP accept it?
Does this plan serve my permanent address and include my providers?
How does its Part D coverage handle my prescriptions and pharmacy?
Which enrollment period applies to my requested change?
What happens to my coverage if my Medicaid status changes?

Frequently asked questions

Important notice

Plan availability, benefits, and any Part B premium reduction vary by county, plan, and individual circumstances. The Annual Enrollment Period (Oct 15 – Dec 7, 2026) is different from your Initial Enrollment Period around your 65th birthday.
We do not offer every plan available in your area. We are not affiliated with or endorsed by the U.S. government or the federal Medicare program. Any information we provide is limited to the plans we offer in your area. To find all of your options, contact Medicare.gov, 1-800-MEDICARE, or the Texas Health Information, Counseling and Advocacy Program (HICAP).
RGI Group is an independent Texas insurance agency, not Medicare or CMS. Consultations have no cost and no obligation to enroll. A request is not a confirmed appointment, enrollment, or completed Medicare permission-to-contact or scope-of-appointment. Any required permissions are handled separately before plan-specific marketing. Do not submit Medicare IDs, Social Security numbers, medical details or prescription lists through this form.

Talk with a licensed Texas agent

Call 346-888-0811. Office: 5900 Balcones Drive, Ste 100, Austin, TX 78731. Monday–Sunday, 8:00 AM–11:00 PM. Licensed in Texas. Guidance available in English and Spanish.