Maryland residents eligible for both Medicare and Medicaid can begin enrolling in Dual Eligible Special Needs Plans starting Oct. 15, 2025, through Dec. 7, 2025, a period that aligns with the annual Medicare open enrollment. These plans, offered by private insurers under Medicare Advantage, aim to streamline benefits between the two programs, ensuring participants access the most appropriate coverage for their needs. Eligibility typically requires meeting criteria related to disabilities, low income or specific health conditions, with nearly half of qualifying individuals nationwide not yet enrolled in such plans.
The coordination aspect addresses gaps where Medicare covers primary medical services like hospital stays and doctor visits, while Medicaid handles long-term care, prescriptions or community-based supports. By integrating these, Dual Eligible Special Needs Plans reduce administrative hurdles and potential out-of-pocket costs for enrollees. Plans available in Maryland include UnitedHealthcare Dual Complete MD-S002, which provides a $121 monthly credit for over-the-counter items, healthy food and utilities, along with zero-dollar prescription drugs. Other options encompass Johns Hopkins Advantage MD Dual Prime, featuring all original Medicare benefits plus extras like transportation to medical appointments. CareFirst BlueCross BlueShield’s DualPrime requires full dual eligibility and residence in the state, covering services such as labs and physical therapy. Kaiser Permanente offers Dual Complete and Dual Essential plans for those in service areas including parts of Southern Maryland.
Marian Cabanillas, Community and State CEO for UnitedHealthcare, said the plans offer many services to contribute to a person’s overall quality of life.
“You may be able to get vision coverage, hearing coverage and dental care,” Cabanillas outlined. “That might include things like checkups or dental cleanings, things of that nature, which are really important to stay healthy.”
However, the recent passage of the Trump administration’s One Big Beautiful Bill Act introduces potential complications. The legislation imposes $1 trillion in cuts to Medicaid, the largest in the program’s history, and adds more requirements for accessing benefits. These changes, effective in phases starting 2026, alter the federal matching rate for state Medicaid spending and impose stricter verification processes. Analysts note this could strain state budgets, prompting reductions in optional services that many dual eligibles depend on.
Hannah Diamond, senior policy advocate for the advocacy group Justice in Aging, said such steep cuts could lead to cuts in optional Medicaid services for dual plan enrollees.
“Because states have to balance their budget, we are very concerned about cuts to optional Medicaid services,” Diamond explained. “Like home and community-based services that many people dually eligible rely on.”In Maryland, where approximately 140,000 individuals are dually eligible as of January 2024, the impacts could reverberate through local health systems. The state’s Medicaid program, administered by the Maryland Department of Health, already coordinates with Medicare for these beneficiaries, but budget constraints might limit expansions or force reevaluations of home-based care options. Studies indicate that Medicaid cuts often result in higher emergency room visits and hospitalizations among duals, increasing overall costs. One analysis estimates that similar federal reductions could lead to coverage losses for up to 60% of dual-benefit enrollees in affected states.
Nationwide, about 12.5 million people qualify as dual eligibles, with enrollment in Dual Eligible Special Needs Plans reaching roughly 3.5 million as of 2024, leaving a significant portion without the integrated coverage. In Maryland, duals represent 19% of Medicare beneficiaries and 35% of Medicaid spending, totaling around $5.6 billion annually. The Hilltop Institute at the University of Maryland, Baltimore County, tracks these figures, noting that full-benefit duals receive comprehensive Medicaid services, while partial duals get help with Medicare premiums and cost-sharing.
For Southern Maryland residents in counties like Calvert, Charles and St. Mary’s, where dual enrollment stands at several hundred per plan—such as 321 in Charles for UnitedHealthcare’s top D-SNP—local access points include community health centers and senior services. The Calvert County Department of Community Resources offers assistance through its Office on Aging, which guides eligibles on applications via phone at 410-535-4606 or in-person at centers in North Beach and Prince Frederick. In Charles County, the Department of Community Services provides similar support at its Waldorf Senior and Recreation Center, reachable at 301-638-4420. St. Mary’s County residents can contact the Department of Aging and Human Services at 301-475-4200, ext. 1050, for enrollment help, often coordinating with providers like Humana or Aetna, which offer D-SNPs with allowances for groceries and utilities.
To enroll, individuals must confirm dual status through Maryland’s Medicaid system or Social Security, then select a plan via Medicare.gov or by calling 1-800-MEDICARE. Plans must meet Centers for Medicare & Medicaid Services standards, including care coordination teams that develop personalized plans. Starting in 2025, some D-SNPs include rollover features for unused allowances, enhancing flexibility. By 2030, federal rules will require certain D-SNPs to align exclusively with state Medicaid managed care organizations, potentially streamlining options further.
Maryland’s dual eligible population has grown 15% since 2020, driven by aging demographics and expanded Medicaid under the Affordable Care Act. In Southern Maryland, where rural access to specialists can be limited, these plans often include telehealth and transportation benefits to bridge gaps. Local health departments in the tri-county area report assisting over 1,000 duals annually with navigation, emphasizing the need for timely enrollment to avoid coverage lapses. As federal changes loom, state officials monitor impacts through the Maryland Primary Care Program, which integrates duals into value-based care models.
The program’s roots trace to 2007 federal authorization for Special Needs Plans, with D-SNPs specifically targeting duals to improve outcomes and reduce costs. In Maryland, adoption has increased 20% in the past five years, reflecting broader national trends toward managed care for this vulnerable group. Enrollment data show disparities, with urban areas like Baltimore seeing higher participation rates than rural Southern Maryland, where outreach efforts continue through community partnerships.