What Is a Dual Special Needs Plan (D-SNP)? Ride Benefits for Medicare and Medicaid Members

Many of your Medicaid riders also have Medicare, and millions of them are in a plan built only for people with both. Those plans often carry their own ride benefit, with its own vendor, trip limits, and booking rules. Knowing which benefit a trip falls under tells you who sends it, who pays for it, and what paperwork comes with it.

What a dual special needs plan is

Federal rule 42 CFR 422.2 defines a dual eligible special needs plan, or D-SNP, as a Medicare Advantage plan only for people entitled to Medicaid. It must coordinate Medicare and Medicaid services, may cover Medicaid services itself, and must hold a contract with the state Medicaid agency. Under 42 CFR 422.107, that contract spells out the Medicaid benefits the plan covers, how it checks each member’s Medicaid eligibility, its service area, and its contract period.

D-SNPs come in three levels of integration. CMS’s Special Needs Plan report for September 2026 counted 6,486,061 people in 1,082 D-SNP plans:

Level	What the plan covers	Plans	Enrollees
Coordination-only D-SNP	Medicare benefits, while coordinating the member’s separate Medicaid. It must notify the state of hospital and skilled nursing facility admissions for at least one high-risk group.	667	3,373,778
Highly integrated D-SNP (HIDE SNP)	Medicare plus long-term services and supports or behavioral health, under a capitated state contract	314	2,312,469
Fully integrated D-SNP (FIDE SNP)	Medicare and Medicaid through one company holding both contracts, including primary and acute care, long-term care, behavioral health, home health, and medical equipment	101	799,814

A D-SNP is a plan, not a person. The rider who joins one is a dual eligible. PACE is a separate program for people 55 and older who need a nursing home level of care, and it must cover every Medicare service and every Medicaid service in the state plan (42 CFR 460.92). See PACE transportation contracts.

Why many D-SNPs include rides

Original Medicare covers only limited non-emergency ambulance transport, so routine rides to the doctor are not a Medicare benefit (SMD 23-006, September 28, 2023). See does Medicare cover NEMT. A Medicare Advantage plan may add them as a supplemental benefit: something Medicare does not cover that helps diagnose, prevent, or treat an illness or injury, or cuts avoidable emergency and health care use (42 CFR 422.100(c)(2)).

CMS’s Medicare Managed Care Manual, Chapter 4, sets three conditions for a ride benefit: the rides must serve the member’s health care needs, the plan must arrange or provide them, and the plan must describe the benefit in its yearly benefit filing. D-SNPs can fund these extras with the rebates Medicare Advantage plans earn when they bid below the benchmark, CMS’s May 27, 2021 FAQs explain.

Plans set their benefits each year, and changes start January 1. A plan must tell members about January 1 changes at least 15 days before the fall open enrollment period begins (42 CFR 422.111(d)).

Three 2026 D-SNPs show how different the benefit can be:

Plan, 2026	Ride benefit	Who runs the rides
Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP), Washington	24 one-way trips a year to plan-approved places in the service area, up to 50 miles each, booked at least 72 hours (3 business days) ahead. Members with cancer, chronic kidney disease, or end stage renal disease get unlimited trips.	Members call Customer Care, which sends them to the plan’s transportation provider
Aetna Medicare Dual Extra (PPO D-SNP) H2293-021, Georgia	24 one-way trips a year, up to 60 miles each, booked at least 2 business days ahead, by taxi, transport van, or rideshare	SafeRide
UHC Dual Complete MI-V001 (HMO-POS D-SNP) H2247-003, Michigan	24 one-way trips for the 2026 plan year to approved places, such as medical appointments, gyms, and pharmacies	MTM Health, on the plan’s vendor sheet

A round trip counts as two one-way trips in the Aetna plan, so a member on dialysis three times a week can use 24 trips in four weeks. After that, the rider may still qualify for Medicaid rides. See UHC Dual Complete and the Medicare Advantage transportation guide for more plans.

How D-SNP ride vendors differ from Medicaid brokers

	D-SNP ride benefit	Medicaid NEMT
Who hires the ride manager	The D-SNP	The state Medicaid agency, or a Medicaid health plan
Is it required	No. An optional supplemental benefit the plan picks each year.	Yes. The state must ensure necessary rides to and from providers (42 CFR 431.53).
Federal rules for the ride manager	Medicare Advantage rules for first tier and downstream entities (42 CFR 422.504(i))	The broker rule in 42 CFR 440.170(a)(4), or managed care rules when the broker is a prepaid ambulatory health plan
How many rides	A yearly cap, such as 24 one-way trips, often with a mileage cap	Necessary rides by the least costly mode that fits the rider’s needs
Where rides go	Plan-approved places, which can include gyms and pharmacies	Medicaid-covered services, generally at the nearest qualified provider
Help at the door	Set by the plan. Aetna’s Georgia plan says drivers are not responsible for helping between the door and the vehicle.	Set by state rules and the broker’s manual
Who pays first	Medicare, where benefits overlap	Medicaid, as payer of last resort

The vendor contract is where most of the difference shows up. Under 42 CFR 422.504(i), the plan stays fully responsible to CMS and must bind every first tier and downstream entity to its terms. A first tier entity is the vendor the plan hires; your company, contracting with that vendor, is a downstream entity. Each one must agree that HHS and the Comptroller General can audit its records for 10 years after the contract period ends or an audit is completed, whichever is later, that no payment goes to anyone on Medicare’s preclusion list, and that members are never billed for amounts the plan owes.

How to get D-SNP ride trips

1. Find the D-SNPs in your counties. Search Medicare Plan Finder by ZIP code, or read CMS’s monthly Special Needs Plan report, which lists D-SNPs by plan, state, and enrollment.
2. Find each plan’s ride vendor. Read the transportation row in the plan’s Evidence of Coverage and any vendor information sheet. Aetna’s Georgia plan names SafeRide, and UnitedHealthcare’s Michigan sheet names MTM Health.
3. Apply to the vendor’s network. Our MTM Health, SafeRide Health, and Modivcare guides explain how each one adds transportation companies.
4. Expect Medicare contract terms. Plan on the 10-year audit access, the vendor’s checks of your company and drivers against federal lists such as the OIG exclusion list, and a clause barring you from billing members.
5. Keep your Medicaid enrollment and broker contract. The same rider can take a plan trip one day and a Medicaid trip the next. Check which benefit covers each trip before you run it, and bill that payer. See third party liability.
6. Recheck every January. Trip limits and vendors can change on January 1, so confirm each plan’s benefit and vendor before the new year’s standing orders start.

Federal rules are pushing the two programs into one company. Starting in 2027, under 42 CFR 422.514(h), a company that runs both a D-SNP and a Medicaid plan for full-benefit dual eligible members in the same area must limit new D-SNP enrollment to its Medicaid members. Where that Medicaid plan also covers rides, ask whether one vendor will handle both benefits for the same rider.