Medicare Special Needs Plans: D-SNP, C-SNP and I-SNP
Special Needs Plans are Medicare Advantage plans for specific groups: people with Medicare and Medicaid, people with certain chronic conditions, and people who need nursing-home-level care. Here is who qualifies for each, how they differ, and every 2027 plan by state.
The three types
| Type | Who can join | 2027 state listings |
|---|---|---|
| D-SNP (dual-eligible) | People with both Medicare and Medicaid. Each plan sets which Medicaid groups it accepts; some take people with partial benefits such as a Medicare Savings Program. | 1,052 |
| C-SNP (chronic condition) | People with a severe or disabling chronic condition the plan serves, confirmed with their doctor or another clinician. | 771 |
| I-SNP (institutional) | People who live, or are expected to live, at least 90 days in a nursing home or similar facility, or who need that level of care at home. | 189 |
Every Special Needs Plan must include Part D drug coverage, and you can stay in one only while you meet its rules. Counts are plans per state they’re sold in, from the CMS 2027 landscape file.
D-SNPs and Medicaid integration
All D-SNPs coordinate with your state Medicaid program, but how far they go differs. Federal rules sort them into levels:
- Fully integrated (FIDE): one company holds both the Medicare Advantage contract and the Medicaid managed care contract, and covers your Medicare and Medicaid benefits, including long-term care, through one plan.
- Highly integrated (HIDE): the company, or one related to it, also covers some Medicaid benefits under a contract with the state, such as long-term services or behavioral health.
- Applicable integrated plans: use one combined process for Medicare and Medicaid appeals and grievances.
- Coordination-only: the plan coordinates with Medicaid, but your Medicaid benefits come separately.
For 2027, 396 of the 1,052 D-SNP state listings are fully integrated, highly integrated or applicable integrated plans. 739 are listed by CMS as Medicare zero-dollar cost sharing D-SNPs. If you’re in the QMB program, Medicaid pays your Medicare deductibles, coinsurance and copays, so the plan’s network and how it works with Medicaid matter more than its out-of-pocket maximum.
C-SNPs: which conditions
Most C-SNPs serve a group of related conditions. For 2027, 677 of the 771 C-SNP state listings serve diabetes together with chronic heart failure (and usually cardiovascular disorders). How often each condition appears:
| Condition | C-SNP state listings that serve it |
|---|---|
| Diabetes | 685 |
| Cardiovascular disorders | 683 |
| Chronic heart failure | 678 |
| Chronic kidney disease | 44 |
| Chronic lung disorders | 32 |
| Chronic mental health conditions | 5 |
| Post-kidney transplant | 3 |
| Obesity and metabolic syndrome | 2 |
| HIV/AIDS | 1 |
| Substance use disorders | 1 |
| Dementia | 1 |
How we sort
D-SNPs are sorted by CMS star rating, then by integration level (fully integrated, highly integrated, applicable integrated plan, then coordination-only), then by worst-case year. C-SNPs and I-SNPs are sorted by worst-case year: 12 months of premiums plus the in-network out-of-pocket maximum, as in our Medicare Advantage rankings. Plans under CMS sanction aren’t listed. Star ratings are for the company contract and are shown for context. Methodology
Pick your state
| State | D-SNPs | C-SNPs | I-SNPs | Integrated D-SNPs |
|---|---|---|---|---|
| Alabama | 28 | 17 | 3 | 0 |
| Arizona | 11 | 42 | 5 | 11 |
| Arkansas | 20 | 9 | 1 | 0 |
| California | 50 | 77 | 8 | 45 |
| Colorado | 23 | 12 | 4 | 1 |
| Connecticut | 12 | 8 | 1 | 0 |
| Delaware | 6 | 7 | 1 | 3 |
| District of Columbia | 3 | 0 | 1 | 2 |
| Florida | 130 | 110 | 12 | 66 |
| Georgia | 39 | 16 | 7 | 0 |
| Hawaii | 6 | 3 | 0 | 6 |
| Idaho | 5 | 4 | 2 | 4 |
| Illinois | 4 | 23 | 3 | 4 |
| Indiana | 12 | 21 | 9 | 6 |
| Iowa | 9 | 7 | 7 | 4 |
| Kansas | 7 | 10 | 3 | 5 |
| Kentucky | 22 | 15 | 6 | 13 |
| Louisiana | 34 | 17 | 3 | 8 |
| Maine | 14 | 3 | 1 | 0 |
| Maryland | 13 | 2 | 2 | 0 |
| Massachusetts | 17 | 1 | 0 | 17 |
| Michigan | 30 | 17 | 3 | 15 |
| Minnesota | 8 | 5 | 0 | 8 |
| Mississippi | 36 | 12 | 3 | 0 |
| Missouri | 34 | 18 | 9 | 0 |
| Montana | 4 | 0 | 0 | 0 |
| Nebraska | 12 | 3 | 3 | 6 |
| Nevada | 22 | 17 | 1 | 0 |
| New Hampshire | 0 | 4 | 1 | 0 |
| New Jersey | 5 | 7 | 3 | 5 |
| New Mexico | 10 | 12 | 0 | 7 |
| New York | 50 | 20 | 9 | 31 |
| North Carolina | 28 | 21 | 10 | 0 |
| North Dakota | 2 | 1 | 2 | 0 |
| Ohio | 11 | 24 | 11 | 7 |
| Oklahoma | 14 | 13 | 2 | 0 |
| Oregon | 7 | 13 | 6 | 6 |
| Pennsylvania | 39 | 24 | 8 | 8 |
| Puerto Rico | 27 | 4 | 0 | 27 |
| Rhode Island | 7 | 1 | 1 | 1 |
| South Carolina | 11 | 12 | 6 | 5 |
| South Dakota | 5 | 0 | 2 | 0 |
| Tennessee | 16 | 27 | 7 | 8 |
| Texas | 119 | 67 | 7 | 31 |
| Utah | 11 | 5 | 2 | 0 |
| Virginia | 18 | 19 | 5 | 9 |
| Washington | 24 | 16 | 4 | 9 |
| West Virginia | 15 | 1 | 3 | 0 |
| Wisconsin | 22 | 4 | 2 | 18 |
States not listed have no Special Needs Plans in the CMS 2027 landscape file.
Questions
What is a D-SNP?
A Medicare Advantage plan only for people who have both Medicare and Medicaid. It includes Part D drug coverage and works with your state Medicaid program; integrated D-SNPs also cover some or all of your Medicaid benefits.
What is a C-SNP?
A Medicare Advantage plan only for people with certain severe or disabling chronic conditions, such as diabetes, chronic heart failure or chronic lung disorders. The plan must confirm your condition with your doctor or another clinician.
What is an I-SNP?
A plan for people who live, or are expected to live, at least 90 days in a nursing home or similar facility, or who need that level of care while living at home.
When can I join a D-SNP?
During the usual Medicare enrollment periods. People with both Medicare and full Medicaid can also join or switch to an integrated D-SNP once a month.
Do Special Needs Plans have $0 premiums?
Many do. Of the 2,012 state listings for 2027, 1,512 have a $0 monthly premium. You still pay the Part B premium unless Medicaid or a Medicare Savings Program pays it.
Sources
- CMS, CY 2027 Medicare Advantage and Prescription Drug Plan Landscape (CY2027_Landscape_202609.csv) — cms.gov; 2027 Star Ratings Data Tables — cms.gov.
- Medicare.gov, “Special Needs Plans” — medicare.gov.
- 42 CFR 422.2 (FIDE and HIDE SNP, special needs individual, severe or disabling chronic condition), 422.52 (SNP eligibility and condition verification), 422.629 (applicable integrated plans) — ecfr.gov, read October 28, 2026.
Educational information, not a recommendation to join any plan. We are not an insurance agent or broker, and we are not connected with or endorsed by the U.S. government or the federal Medicare program. · Advertiser disclosure