Beginning January 1, 2026, PriorityMedicare Dual Premier® (HMO D-SNP) replaced PriorityMedicare D-SNP in some southwest and southeast Michigan counties. Dual Premier, which is a Highly Integrated Dual-Eligible Special Needs Plan (HIDE-SNP), combines Medicare, Medicaid and Long-Term Services & Supports (LTSS) into one plan for an integrated member and provider experience.
What’s the difference between HIDE-SNP and D-SNP?
D-SNP is coordination-only—so members could have Medicare and Medicaid plans from different payers. HIDE-SNP will be one plan, with one payer. Providers will now have one health plan to interact with for each member, rather than two. This applies to member eligibility, claims, appeals and grievances, inquiries, etc.
How do providers participate with Dual Premier?
If you’re contracted with either our Medicare or Medicaid product lines, you should see our Dual Premier members. No new contract is needed. However, to be fully reimbursed, you must be enrolled in the Community Health Automated Medicaid Processing System (CHAMPS), even if you are out of network for Medicaid. Additional resources for CHAMPS provider enrollment can be found here.
Member eligibility requirements
Members must be 21 or over at the time of enrollment, must live in one of the eligible Michigan counties and be enrolled in both Medicare and full Medicaid. They also cannot be residing in a state-operated veteran’s home or be incarcerated, and they can’t be currently enrolled in hospice, unless the member elects hospice while on the Dual Premier plan.
In 2026, eligible counties include:
- Barry
- Berrien
- Branch
- Calhoun
- Cass
- Kalamazoo
- Macomb
- St. Joseph
- Van Buren
- Wayne. In 2027
Beginning Jan. 1, 2027, Dual Premier will be offered in all regions of Michigan’s Lower Peninsula. PriorityMedicare D-SNP will no longer be offered anywhere in Michigan beginning in 2027.
Billing
Bill Priority Health once. The Medicare side of the member’s plan pays out first, then Medicaid picks up the difference, if there is one. If you’re out-of-network for Medicare or Medicaid, that side of the claim will be paid at the out-of-network level on the fee schedule. (As a reminder, providers are forbidden from balance-billing HIDE-SNP members, even if out of network.)
Member information
Eligible members should be directed to priorityhealth.com/mapd-plan-info/dual-plan-documents for more information. They can also find a full list of benefits in the Member Handbook.
Provider resources
We have a number of resources and training opportunities for providers on the subject of PriorityMedicare Dual Premier and HIDE-SNP, including:
- Dual Premier provider page on our Provider Manual
- Dual Premier provider FAQs
- Downloadable PDF PriorityMedicare Dual Premier provider manual
Was this communicated previously?
Yes, this was originally communicated at the end of October 2025.
What about the annual Model of Care training requirement?
Providers who see Dual Premier members will be required to complete the annual Model of Care (MOC) training, but it is not a separate requirement from the D-SNP MOC training. Completing the training once will fulfill the 2026 requirement for both plans.