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2026 Changes for People With Medicare and Medicaid: What You Need to Know

## **Important Disclaimer:** *This information is for educational purposes only and does not constitute marketing of any specific Medicare plan. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. This material is not affiliated with or endorsed by the federal Medicare program.*

**What's Changing for Dual-Eligible Beneficiaries in 2026: A Plain-Language Guide**

**Quick Answer:** If you have both Medicare and Medicaid, 2026 brings several changes designed to make the two programs work together more smoothly. The biggest shifts: a new monthly enrollment window (replacing the old quarterly one) for moving into integrated plans, a push toward "aligned" plans where your Medicare and Medicaid come from the same company, the end of a benefit program called VBID that some plans used to offer extras, and new verification rules for certain over-the-counter benefits. None of these change the core fact that you keep both Medicare and Medicaid—they're about how the plans are structured. Here's what each change means for you, in plain language.

If you have both Medicare and Medicaid, you may have heard that "things are changing" in 2026 — and that can sound alarming. The good news: most of these changes are aimed at making your coverage more coordinated, not at taking anything away. But some of them do affect your choices, your enrollment timing, and the extra benefits you might be used to.

This guide walks through each change in plain English, so you know exactly what to expect and what — if anything — you need to do.

**First, the Big Picture: Why All These Changes Are Happening**

For years, having both Medicare and Medicaid often meant juggling two separate systems that didn't talk to each other. You might have had your Medicare through one company and your Medicaid through another, with separate cards, separate rules, and separate phone numbers — and a lot of confusion in between.

Medicare is phasing in several changes to encourage more coordination between Medicare and Medicaid benefits. These changes are happening gradually — they take place over time, starting in 2024 and continuing through 2030 — so 2026 is one step in a longer journey toward more integrated, coordinated care.

The goal behind nearly all of these changes is "integration" — getting your two programs to function as one smooth system instead of two separate ones.

**Change #1: A New Monthly Enrollment Window (Replacing the Quarterly One)**

This is the change most likely to affect your day-to-day choices, so let's start here.

**What it used to be:** For years, people with both Medicare and Medicaid had a special ability to change their Medicare Advantage or drug plan once per quarter — every three months. In 2018, CMS created a quarterly Special Enrollment Period that permitted dually eligible individuals and Low-Income Subsidy recipients to enroll or disenroll once per quarter.

**What changed:** Effective January 1, 2025, that quarterly enrollment period was eliminated and replaced with two newer, more targeted options. Following the change, dually eligible individuals and Low-Income Subsidy recipients are now able to make monthly changes to their enrollment in certain situations.

Here's how the two replacement windows work, in plain language:

• **A monthly drug-plan window:** There's a new option that allows dually eligible and LIS-eligible individuals to elect a standalone prescription drug plan in any month. You can also use this to move to Original Medicare with a drug plan.
• **A monthly "integrated plan" window:** There's a new Integrated Care Special Enrollment Period that allows full-benefit dually eligible individuals to elect an integrated dual eligible special needs plan in any month, to align coverage with a Medicaid managed care organization.

**The key catch to understand:** This new monthly integrated window is specifically for moving into *aligned* plans — where your Medicare and Medicaid come from the same insurer. This Special Enrollment Period does not apply if you have partial Medicaid benefits or just Extra Help (the Low-Income Subsidy). It also can't be used to hop between regular (non-D-SNP) Medicare Advantage plans.

**What this means for you:** If you have full Medicaid, you have more flexibility than ever to align your two programs under one roof, any month of the year. But the monthly window is now pointed toward integration — it's designed to encourage you into coordinated plans rather than letting you freely switch among all plan types.

**Change #2: The Push Toward "Aligned" Plans**

This is the broader trend driving much of what's happening, and several states are moving on it in 2026.

**What "aligned" means in plain language:** An "exclusively aligned" plan means that your Medicare and Medicaid benefits come from the same plan. Instead of getting Medicare from one company and Medicaid from another, you get both from a single insurer that coordinates everything.

Some states are actively making this shift. Delaware, for example, announced that starting January 1, 2026, it will only allow D-SNPs that are "exclusively aligned," using a "Medicare first" approach — meaning the plan you pick for your Medicare will also take care of your Medicaid benefits. In practical terms, this means that if you are currently getting Medicare and Medicaid from two different plans, you may start getting both from just one plan.

Other states are phasing in similar moves — Michigan, for instance, is launching a new highly integrated D-SNP program on January 1, 2026, as part of a transition taking place over several years.

**What this means for you:** Depending on your state, you may have received a notice that you need to choose a new plan so that your Medicare and Medicaid are aligned. If you got both from two different companies, you may have needed to decide during the fall Open Enrollment Period (October 15–December 7) which single plan to enroll in. If you're unsure whether this affects you, your state Medicaid office or local SHIP can tell you exactly where your state stands.

**Change #3: Curbing "Look-Alike" Plans**

This change happens behind the scenes, but it benefits you, so it's worth understanding.

For years, some regular Medicare Advantage plans enrolled mostly dual-eligible members without being held to the higher coordination standards that true D-SNPs must meet. These are nicknamed "look-alike" plans. CMS has been steadily cracking down on them.

Here's the mechanism: if a Medicare Advantage plan is identified as a "look-alike" by CMS, CMS will not contract — or renew their contract — with the plan. The threshold that triggers this designation has been dropping: in 2025 it fell to 70%, and for plan year 2026 and beyond, it drops further to 60%.

**What this means for you:** This provision helps dually eligible individuals by reducing the incentives to steer them into plans that may not be designed to meet their needs. In plain language: it pushes you toward plans that are genuinely built to coordinate your care, rather than ones that just *look* like they serve dual-eligible members without doing the real coordination work.

**Change #4: The End of VBID (Affecting Some "Extra" Benefits)**

This one is important if you've come to rely on certain non-medical perks from your plan.

Starting in 2026, CMS is ending a program called the Value-Based Insurance Design model — VBID for short. VBID helped Medicare Advantage plans, including D-SNPs, provide extra benefits like lower prescription drug costs or credits to help pay for food, utilities, rides, and housing.

**What this means for you:** Some plans used VBID to fund certain extras, so a few of those specific benefits may look different in 2026. This does *not* mean all extra benefits disappear — many D-SNPs still offer supplemental benefits like dental, vision, and hearing — but the particular menu of perks your plan offers may have shifted. Always review your plan's Annual Notice of Change (the document your plan mails you each fall) to see exactly what your specific plan covers this year.

**Change #5: New Verification for Certain Over-the-Counter Benefits**

If your plan gives you a credit or card for things like healthy food, over-the-counter items, or utility help, there's a new rule worth knowing.

Beginning in 2026, verification of a qualifying chronic condition is required industry-wide before using over-the-counter credits for healthy food and utilities. In plain language: to use certain credits tied to chronic-condition benefits, you may need to have your qualifying health condition verified first.

One practical heads-up: verification is generally tied to your specific plan and insurer. If you complete verification with one company and then switch to a plan with a different carrier, you may need to complete verification again — and you may not be able to carry leftover credits from the old plan to the new one. So if you're switching plans, ask the new plan how their verification works before you assume your benefits carry over.

**Change #6: Better Care Coordination and Protections**

Several quieter 2026 changes are simply designed to improve your experience:

• **Limits on certain out-of-network costs:** Starting in 2026, D-SNP PPO plans will have their cost-sharing amounts limited, which addresses issues with high costs for out-of-network services.
• **Improved language access:** For 2026, CMS is updating the required languages in plan notices to better match the languages actually spoken in your state.
• **More stable benefits during the year:** Plans now must keep their supplemental-benefit eligibility criteria stable — meaning they generally cannot change the rules for those benefits mid-year — plus there are new restrictions on how these benefits can be advertised, to reduce confusion.

**What this means for you:** These are protections working in your favor — more predictable benefits, clearer communication, and lower surprise costs.

**What You DON'T Need to Worry About**

With all this change, it's just as important to know what *isn't* changing:

• **You still keep both Medicare and Medicaid.** None of these changes take away your fundamental eligibility for either program.
• **You're still entitled to all your Medicaid services.** Even with plan restructuring, dual eligibles remain entitled to their full Medicaid benefits.
• **You can still keep Original Medicare if you prefer.** Joining an integrated plan is an option, not a requirement. You can keep Original Medicare alongside your Medicaid if that's what works for you.
• **The work requirements don't apply to you.** As we cover in our companion post on losing Medicaid, people who are dually eligible for both Medicare and Medicaid are not subject to the new Medicaid work requirements.

**What You Should Actually Do**

Here's your simple action plan for navigating the 2026 changes:

1. **Read your plan's Annual Notice of Change.** Every fall, your plan mails you this document explaining what's changing for the coming year. It's the single most important piece of mail for understanding how these changes affect *your* specific coverage.
2. **Check whether your state is moving to aligned plans.** If you get Medicare and Medicaid from two different companies, ask your state Medicaid office or SHIP whether you need to choose a single aligned plan.
3. **Remember your monthly enrollment window if you have full Medicaid.** You now have the flexibility to move into an integrated plan any month of the year — you're not locked into waiting.
4. **Verify chronic-condition benefits before switching plans.** If you rely on food, OTC, or utility credits, confirm how verification carries over before changing carriers.
5. **When in doubt, call your SHIP.** Your State Health Insurance Assistance Program offers free, unbiased counseling and knows your state's specific rules. Navigating these changes is complicated, and you don't have to do it alone.

**Frequently Asked Questions**

**Do the 2026 changes mean I'll lose my Medicare or Medicaid?**

No. These changes are about how plans are structured and coordinated — not about your eligibility. You keep both Medicare and Medicaid, and you remain entitled to all your Medicaid services. The changes are designed to make the two programs work together more smoothly.

**What happened to the quarterly enrollment period for people with Medicare and Medicaid?**

Effective January 1, 2025, the old quarterly Special Enrollment Period was eliminated. It was replaced by a monthly window to choose a standalone drug plan, and a separate monthly "Integrated Care" window for full-benefit dual-eligible individuals to enroll in an aligned, integrated D-SNP that matches their Medicaid plan.

**What is an "aligned" or "integrated" plan?**

It's a plan where your Medicare and Medicaid benefits both come from the same insurance company, coordinated together. Instead of two separate plans with separate cards and rules, you get both through one plan. Some states are requiring this kind of alignment starting in 2026.

**Can I still keep Original Medicare instead of joining an integrated plan?**

Yes. Joining an integrated D-SNP is a choice, not a requirement. You can keep Original Medicare alongside your Medicaid if you prefer. The monthly enrollment windows give you flexibility, but they don't force you into any particular type of plan.

**Why do some of my plan's extra benefits look different in 2026?**

A federal program called VBID, which some plans used to fund extras like food, utility, and housing credits, is ending in 2026. This may change the specific menu of perks your plan offers. Many plans still offer supplemental benefits like dental and vision — check your Annual Notice of Change to see exactly what your plan covers.

**Do I need to do anything because of these changes?**

For most people, the key step is simply reading your plan's Annual Notice of Change each fall and confirming whether your state is moving to aligned plans. If you have full Medicaid and want to switch to an integrated plan, you can now do so any month. When in doubt, call your local SHIP for free guidance.

**The Bottom Line on 2026 Dual-Eligible Changes**

The 2026 changes for people with both Medicare and Medicaid can feel overwhelming, but the underlying goal is genuinely positive: making two complicated programs work together as one coordinated system. The headline shifts — a monthly enrollment window, a push toward aligned plans, the end of VBID, and new benefit verification rules — are mostly about *structure*, not about taking away your coverage.

Your eligibility is intact. Your Medicaid services continue. And you have more tools than ever to coordinate your care under one roof if you choose to. The most important thing you can do is stay informed: read your Annual Notice of Change, know your state's direction, and lean on your free SHIP counselors whenever the details get confusing.

**Need Additional Help?**

For questions about how the 2026 changes affect your dual coverage:

• Visit Medicare.gov and use the Plan Finder to see integrated plans available in your area
• Call 1-800-MEDICARE for guidance on your Medicare coverage options
• Contact your state Medicaid office to ask about aligned-plan requirements in your state
• Contact your local State Health Insurance Assistance Program (SHIP) for free, unbiased, one-on-one counseling — they know your state's specific rules

**Required Compliance Disclaimers:**

*For agent use only. Not affiliated with the U.S. federal government or federal Medicare program. This information is provided for educational purposes only and does not constitute marketing of any specific Medicare plan.*

*For official Medicare information, please visit Medicare.gov or call 1-800-MEDICARE. You can also contact your local State Health Insurance Program (SHIP) for personalized assistance.*