Comparing MMAI, FIDE SNP, and Medicare Advantage Plans

Program Element

MMAI PLAN

FIDE SNP

Medicare Advantage Plans that are not FIDE SNPs

Cover all Medicare and Medicaid benefits, including primary and acute care services, behavioral health services, and long-term services and supports

Yes

Yes

No - only Medicare benefits covered

Offer supplemental benefits

Yes

Yes

Yes

Tailor benefits, including supplemental benefits, specifically for the needs of dually eligible individuals

Yes

Yes

No

Offer $0 Prescription Co-Pays

Yes

·       $0 for waiver and nursing home members

·       Very small copayments for members who do not receive waiver and nursing home services 

·       Members qualify for the Extra Help program which limits copays, see Help with drug costs | Medicare

·       In CY 2026, Extra Help co-pays for generic drugs are up to $5.10  and co-pays for brand-name drugs are up to $12.64 (and $0 for people receiving waiver or nursing home services)

·       Once your total drug costs (including co-pays) reach $2,000, you’ll pay $0 for each covered drug

Same as FIDE SNP

One care coordinator for both Medicare and Medicaid benefits. Care coordinator[s] help members:

• Manage their health care

• Arrange help at home, behavioral health, nursing care, depending on the needs

• Get extra services, like food services

Yes

Yes

No

Must have enrollee advisory committees to gather feedback from their members about how to improve access to services, care coordination, and health equity

Yes

Yes

No

One health risk assessment with members to understand members’ physical, behavioral, and social needs and risk factors for both Medicare and Medicaid

Yes

Yes 

No

Model of care to describe how the plan will meet the needs of dually eligible individuals

No

Yes

No

Continuity of care period of no less than 90 days during which the plan will cover the current services the member receives  

Yes

Yes

Yes

Unified appeal & grievance process that enable plan members to file a single appeal or complaint with the plan, regardless of whether a service is covered by Medicare, Medicaid or both

Yes

Yes

No

Continuation of existing benefits during appeals (if a plan is going to terminate or reduce a benefit that was previously approved, it must continue providing that benefit during the appeal process if the member requests an appeal and continuation of the benefit)

Yes

Yes

Yes, in certain circumstances

Provide members with a single member ID card for both Medicare and Medicaid benefits

Yes

Yes

No

Provide information about the covered benefits —including the benefits typically covered by Medicare and the benefits typically covered by Medicaid—in a single set of materials that are easier to understand than separate materials for Medicare and Medicaid benefits

Yes

Yes

No

Choice of network of providers

Yes

Yes, call the FIDE SNP to see if a provider is in the plan’s network or visit their website to look through their provider directory 

Yes, call the plan to see if a provider is in the plan’s network or visit their website to look through their provider directory