Top Medicare Plans for Dual-Eligible Individuals in Illinois

If you qualify for both Medicare and Medicaid in Illinois, understanding your healthcare options is key as the state transitions to Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) starting January 1, 2026. These plans simplify healthcare by combining Medicare and Medicaid benefits into a single, streamlined plan. Here’s what you need to know:

Transition Alert: Illinois is replacing the Medicare-Medicaid Alignment Initiative (MMAI) with FIDE-SNPs. Current MMAI enrollees will be automatically shifted to a FIDE-SNP unless they choose otherwise.
Enrollment Period: Sign up during the Annual Enrollment Period (Oct 15–Dec 7, 2025) for coverage starting Jan 1, 2026. Special Enrollment Periods are available for changes after this date.
Key Providers: Four carriers – Wellcare Meridian, Humana, Molina Healthcare, and Aetna – will offer FIDE-SNPs statewide.
Plan Benefits: FIDE-SNPs integrate Medicare and Medicaid services, covering doctor visits, prescriptions, long-term care, behavioral health, and more, often with $0 copays for in-network services.
Extra Perks: Some plans, like Humana’s, include allowances for essentials like groceries or utilities.

This shift ensures streamlined care for dual-eligible individuals, reducing complexity and improving access to services. Compare plans carefully to find the best fit for your needs.

Medicare-Medicaid Plans End in 2026

FIDE-SNP Plans Explained

FIDE-SNP plans are the go-to Medicare option for individuals in Illinois who qualify for both Medicare and Medicaid. These plans simplify healthcare by combining benefits from both programs into a single, streamlined plan.

What Is a FIDE-SNP?

A FIDE-SNP, or Fully Integrated Dual Eligible Special Needs Plan, is a specific type of Medicare Advantage plan that integrates Medicare and Medicaid benefits into one cohesive package. Unlike traditional Medicare Advantage plans, FIDE-SNPs are designed to include Medicaid benefits as well.

With FIDE-SNPs, members benefit from integrated materials, a single provider network for all services, one ID card, and a unified appeal process. This eliminates the hassle of managing multiple insurance cards or navigating separate provider networks.

Illinois has chosen FIDE-SNPs as the exclusive option for dual-eligible individuals because they align closely with the previous MMAI program, ensuring a smooth transition for members. To operate, FIDE-SNP carriers must have contracts with both the Centers for Medicare & Medicaid Services (CMS) for Medicare benefits and the Illinois Department of Healthcare and Family Services (HFS) for Medicaid benefits. This dual oversight ensures that plans meet both federal and state requirements.

What FIDE-SNPs Cover

FIDE-SNPs in Illinois offer comprehensive coverage, including Medicare and Medicaid benefits such as long-term services and supports (LTSS), behavioral health, transportation, and prescription drugs. Members can access LTSS either through their FIDE-SNP plan or through a HealthChoice Managed Long Term Services and Supports (MLTSS) plan.

Some plans also include perks like a Healthy Options Allowance, which helps members pay for essentials like groceries, pet care, utility bills, or rent. For example, Humana Dual Fully Integrated (HMO D-SNP) combines Medicare and Medicaid coverage with prescription drug benefits and includes this allowance.

In most cases, Medicare covers the primary healthcare costs, while Medicaid takes care of additional expenses. Many FIDE-SNP plans in Illinois feature $0 copayments for in-network services, including doctor visits, surgeries, rehabilitation, and other covered care. This makes healthcare more accessible for those with limited financial resources.

Next, let’s explore the carriers offering these plans across Illinois.

FIDE-SNP Carriers in Illinois

Now that the benefits are clear, it’s time to look at the carriers providing these plans. Illinois selected four managed care organizations through a competitive process to offer FIDE-SNP plans statewide, ensuring they meet CMS network adequacy standards for all counties.

Wellcare Meridian Dual Align (HMO D-SNP): Available from January 1, 2026, through Meridian of Illinois. For member services, call 1-844-536-2180 (TTY: 711).
Humana Dual Fully Integrated (HMO D-SNP): This plan partners with the Illinois Department of Healthcare and Family Services and includes the Healthy Options Allowance for non-medical essentials.
Molina Medicare Complete Care Plus (HMO D-SNP): Offers coordinated care with the support of a care coordinator to manage healthcare needs. Member services: (877) 901-8181 (TTY: 711).
Aetna Medicare FIDE (HMO D-SNP): Provides statewide coverage. For member and provider services, call 1-800-787-3311 (TTY: 711).

These carriers operate under both state and federal oversight, making FIDE-SNPs the only Medicare Advantage plans in Illinois subject to state regulatory requirements.

Enrollment Periods and Deadlines

Enrolling in your FIDE-SNP on time is crucial as Illinois transitions from MMAI to fully integrated plans. Understanding the enrollment deadlines ensures your coverage continues without interruption. Here’s what you need to know about key dates and enrollment periods.

Annual Enrollment Period

The Annual Enrollment Period (AEP) runs from October 15, 2025, through December 7, 2025. This is the time for individuals eligible for both Medicare and Medicaid to review and update their Medicare coverage. It’s especially important this year, as the Medicare-Medicaid Alignment Initiative (MMAI) ends on December 31, 2025, and the new FIDE-SNP plans officially begin on January 1, 2026.

To ensure your coverage starts on January 1, 2026, submit your enrollment request by December 7, 2025. If you’re currently enrolled in MMAI, you’ll receive an Annual Notice of Change by September 30, 2025, outlining your options. If no action is taken, you may be automatically enrolled in your current carrier’s FIDE-SNP plan (e.g., Molina’s FIDE-SNP). Alternatively, if you decide not to enroll in a FIDE-SNP, you’ll be automatically switched to Original Medicare with a stand-alone prescription drug plan starting January 1, 2026.

Special Enrollment Periods for Dual-Eligible Individuals

In addition to the AEP, there are Special Enrollment Periods (SEPs) offering flexibility for plan changes. In Illinois, two key SEPs are available for dual-eligible individuals:

Integrated Care SEP: This allows eligible individuals to enroll in a FIDE-SNP once per month, giving you the option to switch plans or enroll outside the AEP.
Dual/LIS SEP: This lets dual-eligible individuals who are already in a Medicare Advantage plan (including a FIDE-SNP) switch back to Original Medicare with a stand-alone prescription drug plan or change their prescription drug plan.

It’s important to note that SEPs cannot be used to enroll in or switch between non-D-SNP Medicare Advantage plans.

When Your Coverage Starts

Your coverage start date depends on when you enroll. If you submit your enrollment request during the AEP (October 15–December 7, 2025), your coverage will begin on January 1, 2026. This date marks the statewide launch of FIDE-SNP plans and the official end of the MMAI program, ensuring a smooth transition for your Medicare and Medicaid benefits.

For enrollments processed through an SEP after January 1, 2026, coverage will begin on the first day of the month following your enrollment request. For example, if you enroll in February 2026 via the Integrated Care SEP, your coverage will start on March 1, 2026.

This timeline is designed to help dual-eligible individuals maintain consistent coverage during the transition to FIDE-SNP plans.

FIDE-SNPs vs. Other Medicare Options

Choosing the right Medicare coverage is a big decision, especially for individuals who qualify for both Medicare and Medicaid (dual-eligible). Comparing FIDE-SNPs to other Medicare options can help you better understand which plan aligns with your healthcare needs. Below is a breakdown of how FIDE-SNPs stack up against other choices.

Plan Comparison Table

The table below highlights the key differences among FIDE-SNPs, MMAI plans, Original Medicare combined with Medicaid, and Standard Medicare Advantage plans:

Feature	FIDE-SNPs	MMAI Plans	Original Medicare + Medicaid	Standard Medicare Advantage
Coverage Integration	Combines Medicare and Medicaid benefits into one plan	Combines Medicare and Medicaid benefits into one plan	Medicare and Medicaid managed separately	Covers Medicare benefits only
Provider Network	Unified network for all services	Unified network for all services	Separate networks for Medicare and Medicaid	Medicare network only
Long-Term Services & Supports (LTSS)	Fully included	Fully included	Managed separately through Medicaid	Not covered
Prescription Drug Coverage	Included	Included	Requires a separate Part D plan	Varies by plan
Care Coordination	One care coordinator for all services	One care coordinator for all services	No integrated coordination	Limited to Medicare services
ID Cards	Single card for all services	Single card for all services	Separate cards for Medicare and Medicaid	Separate cards required
Appeals Process	Unified process	Unified process	Separate processes for Medicare and Medicaid	Medicare-only appeals process
Availability in Illinois	Starts January 1, 2026	Ended December 31, 2025	Always available	Always available
Best For	Those needing integrated care, including LTSS	(No longer available)	Individuals who prefer flexibility in providers	Not ideal for dual-eligible individuals

Why FIDE-SNPs Stand Out

FIDE-SNPs simplify healthcare for dual-eligible individuals by combining Medicare and Medicaid benefits into one plan. This approach eliminates the hassle of managing separate programs and ensures all services are coordinated under a single network. In contrast, Standard Medicare Advantage plans only cover Medicare benefits, leaving out essential Medicaid services like long-term care, behavioral health, and transportation.

Original Medicare, while comprehensive for Medicare services, doesn’t offer the same level of integration. Beneficiaries must manage Medicaid services independently and often need a separate Part D plan for prescription drugs. Illinois has opted to offer FIDE-SNPs exclusively starting in 2026 because they closely resemble the integrated care model previously provided by MMAI plans.

When to Consider FIDE-SNPs

FIDE-SNPs are a strong choice for dual-eligible individuals who value coordinated and integrated healthcare. They are particularly beneficial for those requiring long-term services and supports (LTSS), such as assistance with daily tasks like bathing, dressing, or eating. For example, Molina Healthcare extends coverage for skilled nursing facility stays – something not offered by Standard Medicare Advantage plans.

Additionally, FIDE-SNPs improve access to behavioral health services by aligning mental and physical healthcare under one plan. This coordination reduces the risk of conflicting treatments and ensures your care team is on the same page. Transportation and home health services are also streamlined, with a single care coordinator managing all aspects of your care plan.

For individuals who previously benefited from the MMAI program, FIDE-SNPs continue to offer a seamless, integrated care experience. A dedicated care coordinator works with you to create a personalized plan that addresses all your healthcare and support needs.

FIDE-SNPs in Illinois also include added perks like the Healthy Options Allowance offered by carriers such as Humana. This allowance helps cover non-medical expenses like groceries, pet supplies, utility bills, or even rent. While enrollment in FIDE-SNPs is voluntary and you can disenroll at any time using the monthly Dual/LIS Special Enrollment Period, their streamlined and coordinated approach makes them an appealing option for many seeking a hassle-free healthcare experience.

How to Enroll

Getting started with a FIDE-SNP plan is simple if you follow these steps carefully.

Enrollment Steps for FIDE-SNPs

Check your eligibility and gather necessary documents:

Make sure you receive full Illinois Medicaid benefits (AABD or FamilyCare), have Medicare Part A and B, are at least 21 years old, and live in the plan’s service area.
Collect your Medicare card, Medicaid documents, a list of your current medications, a provider list, and any information about chronic conditions.

Compare FIDE-SNP options available in Illinois. Some carriers to consider include Aetna Medicare FIDE (HMO D-SNP), Humana Dual Fully Integrated (HMO D-SNP), Molina Medicare Complete Care Plus (HMO D-SNP), and Wellcare Meridian Dual Align (HMO D-SNP). Look into each plan’s provider network to confirm your doctors participate, review extra benefits like Humana’s Healthy Options Allowance, and ensure your prescription drug needs are covered.

Submit your application during the AEP (October 15–December 7, 2025) for coverage starting January 1, 2026. If you miss this period, dual-eligible individuals can still enroll using the monthly Integrated Care Special Enrollment Period, with coverage beginning the first day of the month after your enrollment request.

If you’re currently enrolled in MMAI, you’ll receive an Annual Notice of Change by September 30, 2025, outlining your options. If no action is taken by December 31, 2025, you’ll be automatically enrolled in the FIDE-SNP offered by your current carrier. However, choosing a plan yourself ensures it aligns with your specific needs.

After applying, contact your chosen plan’s member services to confirm your enrollment and verify your details. You can also reach out to the Illinois Department of Healthcare and Family Services to confirm your Medicaid eligibility.

Need help? The next section explains how to find support during the process.

Where to Get Help

Several resources are available to assist you with enrollment.

Direct Carrier Support:
Every FIDE-SNP carrier provides member support. You can contact Aetna Medicare FIDE at 1-800-787-3311 (TTY: 711), Molina Medicare Complete Care Plus at (877) 901-8181 (TTY: 711), and Wellcare Meridian Dual Align at 1-844-536-2180 (TTY: 711).

The Illinois Department of Healthcare and Family Services (IDHFS) offers resources and online enrollment at enrollhfs.illinois.gov.

Local Health Insurance Brokers:
Brokers such as Illinois Health Agents provide personalized guidance at no cost. They can help compare FIDE-SNP plans, explain differences between carriers, and assist with enrollment.

Illinois Health Agents, rated "EXCELLENT" based on 127 reviews, is known for its clear communication and thorough follow-up. For assistance, call 312-726-6565 or email [email protected].

After You Enroll

Once your application is approved, here’s what to expect next.

You’ll receive important materials from your selected FIDE-SNP carrier. Your new member ID card will arrive by mail, combining Medicare and Medicaid coverage into a single card for easier access to services.

A Member Handbook will also be provided, detailing covered benefits, plan rules, and how to access services. Take time to review this handbook to understand your coverage, identify any restrictions, and learn how to file claims or appeals.

Your assigned care coordinator will contact you to set up an initial appointment. They’ll work with you to create an Individualized Care Plan tailored to your health and support needs.

You’ll also get a directory of in-network providers, including doctors, specialists, hospitals, and other facilities. Use this to confirm your current providers are included or to find new ones if needed.

For enrollments made during the Annual Enrollment Period, coverage begins on January 1, 2026. If you need to switch plans or disenroll, you can use the monthly Integrated Care Special Enrollment Period. Additionally, you can return to Original Medicare and Fee-for-Service Medicaid through the Dual/LIS Special Enrollment Period.

Conclusion

The transition from MMAI to FIDE-SNPs in Illinois is a critical shift for dual-eligible individuals, with MMAI ending on December 31, 2025, and FIDE-SNPs beginning January 1, 2026. Since this change impacts all MMAI enrollees, taking timely action is key to maintaining uninterrupted benefits. As discussed earlier, FIDE-SNPs simplify care coordination and ensure continuous access to essential services.

Illinois opted exclusively for FIDE-SNPs over other D-SNP types because they closely mirror the structure and benefits of MMAI programs. Several carriers, including Aetna Medicare FIDE, Humana Dual Fully Integrated, Molina Medicare Complete Care Plus, and Wellcare Meridian Dual Align, provide statewide coverage, giving you a variety of plans to evaluate based on your healthcare priorities.

To secure coverage starting January 1, 2026, enroll during the Annual Enrollment Period (October 15–December 7, 2025). If you miss this window, monthly special enrollment periods are available, offering added flexibility.

When choosing a plan, compare provider networks, prescription drug coverage, and any extra benefits. Carefully assess your healthcare needs to ensure the plan you pick aligns with your requirements. For guidance, resources like Illinois Health Agents offer free, personalized assistance. They can help you compare plans and complete your enrollment – contact them at 312-726-6565 or [email protected].

FIDE-SNPs also allow monthly plan changes through special enrollment periods, giving you the flexibility to adapt if your needs change. While participation in FIDE-SNPs is voluntary, these plans maintain the integrated benefits that many rely on.

Act promptly to protect your access to coordinated Medicare and Medicaid services. Making an informed choice now ensures you continue to receive the comprehensive coverage necessary for your health and well-being.

FAQs

How can I smoothly transition from an MMAI plan to a FIDE-SNP plan in Illinois?

To make switching from an MMAI (Medicare-Medicaid Alignment Initiative) plan to a FIDE-SNP (Fully Integrated Dual Eligible Special Needs Plan) in Illinois as smooth as possible, follow these steps:

Understand your current coverage: Take a close look at your MMAI plan. Know what benefits it offers and any limitations it might have, so you can identify what you’ll need in a FIDE-SNP plan.
Check eligibility and timing: Make sure you meet the qualifications for a FIDE-SNP plan and enroll during the correct Medicare enrollment period.
Compare available plans: Explore options that provide a range of benefits, including medical coverage, prescription drugs, and extras designed for dual-eligible individuals. Keep affordability and access to your preferred healthcare providers in mind.
Get expert advice if needed: If the process feels overwhelming, reach out to a licensed health insurance broker, such as Illinois Health Agents. They can guide you through your options and help you find a plan that works best for your situation.

By following these steps, you’ll be better prepared to transition smoothly while keeping the care and coverage you rely on.

What are FIDE-SNPs, and how do they enhance care coordination for dual-eligible individuals compared to traditional Medicare and Medicaid?

Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) are Medicare Advantage plans specifically tailored for people who qualify for both Medicare and Medicaid. These plans bring together the benefits of both programs, creating a more unified and efficient healthcare experience.

By integrating services such as medical, behavioral, and long-term care into a single plan, FIDE-SNPs simplify healthcare for members. This approach helps close coverage gaps, streamlines billing, and often includes support from a dedicated care manager. For individuals with dual eligibility, these plans can provide more personalized care, improved health outcomes, and a less stressful, cost-effective way to manage their healthcare needs.

What extra benefits do FIDE-SNP plans in Illinois provide, and how can they improve my healthcare experience?

FIDE-SNP (Fully Integrated Dual Eligible Special Needs Plans) in Illinois offer more than just standard Medicare coverage. These plans are specifically designed for individuals who qualify for both Medicare and Medicaid, aiming to streamline care and create a more cohesive healthcare experience.

What sets these plans apart are the extra benefits they often include. You might find coverage for vision, dental, and hearing services, along with transportation to medical appointments and access to fitness programs. Some plans even provide allowances for over-the-counter items and meal delivery services after hospital stays. These added features can make it easier to access care and support your overall health.

By combining Medicare and Medicaid services, FIDE-SNP plans simplify healthcare management, help lower out-of-pocket expenses, and cater to the specific needs of those they serve.