Medicare guide
What Is a Medicare Advantage Special Needs Plan?
A Medicare Advantage special needs plan, or SNP, is a Medicare Advantage plan limited to people with specific needs: those with both Medicare and Medicaid, those with certain chronic conditions, or those who need institutional care. Here is how SNPs differ from regular plans and how to tell whether one fits.
Blake Insurance Group is an independent agency serving clients by phone, email, and online in states where we are licensed; coverage depends on the insurer, the policy, and underwriting.
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How SNPs differ from regular plans
A regular Medicare Advantage plan is open to anyone with Parts A and B in its service area. A SNP adds an eligibility requirement and tailors its benefits, provider network, and drug list to its members. All SNPs must include Part D drug coverage.
Special Needs Plans are Medicare Advantage plans for specific groups, and all must include Part D drug coverage. Medicare.gov describes three types: Dual Eligible SNPs (D-SNPs) for people who have both Medicare and Medicaid; Chronic Condition SNPs (C-SNPs) for people with specific severe or chronic conditions, sometimes limited to one condition or a group of related conditions; and Institutional SNPs (I-SNPs) for people who live in, or need the level of care of, an institution such as a nursing home. You must have Parts A and B and live in the plan’s service area.
KFF counts about 8.2 million SNP enrollees in 2026, 23% of Medicare Advantage enrollment: D-SNPs make up 78% of SNP enrollment, C-SNPs about 1.7 million people after 45% growth from 2025, and I-SNPs about 124,000.
Who can join
- You must have Medicare Part A and Part B.
- You must live in the plan’s service area.
- You must meet the plan’s criteria: Medicaid eligibility for a D-SNP, a qualifying condition for a C-SNP, or institutional-level care for an I-SNP.
When you can enroll
Since January 1, 2025, people with Medicaid or Extra Help can use a monthly Special Enrollment Period to switch into Original Medicare with a standalone drug plan, or between drug plans, but not to join a Medicare Advantage plan. Separately, people with full Medicaid can join or switch to an integrated D-SNP once a month, according to CMS and Medicare.gov.
| Period | When | What you can do |
|---|---|---|
| Initial Enrollment Period | 7 months around your 65th birthday month | Sign up for Parts A and B, and join a plan |
| Annual Open Enrollment | October 15 – December 7 | Join, switch, or drop Medicare Advantage or drug plans; coverage starts January 1 |
| Medicare Advantage Open Enrollment | January 1 – March 31 | One change: switch MA plans or return to Original Medicare (and add a drug plan) |
| General Enrollment Period | January 1 – March 31 | Sign up for Parts A and B if you missed your IEP; penalties may apply |
| Special Enrollment Periods | After qualifying events | For example, moving or losing employer coverage |
| Medigap Open Enrollment | 6 months from the first month you have Part B and are 65+ | Buy any Medigap policy sold in your state without health questions |
Source: Medicare.gov, October 2026.
Questions to ask before enrolling
- Does the plan coordinate with my Medicaid benefits?
- Are my doctors and specialists in network?
- Are my drugs on the formulary?
- What extra benefits and care coordination does it offer?
- What is the plan’s Star Rating, and how has it changed?
Star Ratings
CMS released 2027 Star Ratings on October 8, 2026. About 71% of Medicare Advantage drug-plan enrollees are in contracts rated four stars or higher, 15 contracts earned five stars, and the enrollment-weighted average rating is 3.99. Star Ratings are one input; check the plan’s network, drug list, and costs too.
Wellcare’s D-SNP focus
Wellcare is Centene’s Medicare brand. In its October 1, 2026 announcement of 2027 plans, Wellcare said it serves nearly 10 million standalone drug plan members in all 50 states through its Wellcare Classic and Value Script plans, that dual-eligible members are about 40% of its Medicare Advantage membership, and that D-SNPs make up nearly half of its 2027 Medicare Advantage offerings. KFF reports Centene is exiting 359 counties and entering 15 for 2027, so check whether a Wellcare plan is offered in your ZIP code.
Out-of-pocket protection
Medicare Advantage plans must cap in-network out-of-pocket costs for Part A and B services. For 2026, KFF reports the federal limit is $9,250 in network and $13,900 combined for in- and out-of-network services in PPOs, and that the average plan’s in-network limit is about $5,421. Original Medicare has no out-of-pocket cap, which is one reason people pair it with Medigap.
Medicare costs to know
| Item | 2026 amount |
|---|---|
| Part A hospital deductible | $1,736 per benefit period |
| Part A coinsurance, days 61–90 | $434 per day |
| Skilled nursing facility, days 21–100 | $217 per day |
| Part B standard premium | $202.90 per month |
| Part B deductible | $283 per year |
| Part D deductible (maximum) | $615 |
| Part D out-of-pocket cap | $2,100 |
| Insulin | No more than $35 for a month’s supply |
Sources: CMS (Nov. 2025, Apr. 2025) and Medicare.gov. 2027 Part A and B amounts had not been announced as of Oct. 22, 2026; CMS usually publishes them in mid-November. Higher-income beneficiaries pay more for Parts B and D.
Avoiding late penalties
Medicare charges late penalties if you delay without other qualifying coverage. Medicare.gov says the Part B penalty is 10% for each full 12-month period you could have had Part B but didn’t, usually for as long as you have Part B. The Part D penalty is 1% of the national base beneficiary premium for each month without creditable drug coverage after a 63-day gap; the base premium is $38.99 in 2026 and $41.33 in 2027. You can generally delay Part B without penalty if you have group coverage from current employment, and sign up within eight months after that coverage or employment ends.
Checking a plan and insurer
- Networks. Confirm your doctors and hospitals are in the plan’s network.
- Drugs. Check each prescription on the plan’s formulary and its tier.
- Costs. Compare premiums, deductibles, copays, and the out-of-pocket maximum.
- Agent license. Confirm the agent is licensed in your state through your state insurance department.
- Star Ratings. Review the plan’s rating on Medicare.gov’s Plan Finder.
What an independent agency does
An independent insurance agency is licensed to sell policies from several insurance companies. Instead of quoting one company's products, an independent agent can compare options from the insurers the agency represents, explain the differences in coverage, and help you re-shop at renewal. The insurance company, not the agent, makes underwriting and claim decisions.
Blake Insurance Group is an independent agency. We work with clients by phone, email, and online in states where we are licensed, and we will tell you which insurers we can quote for your situation.
How we work
Blake Insurance Group serves clients by phone, email, and online in states where we are licensed. The insurers and plans we can offer depend on our appointments and your location; a company named on this page may not be available through us.
How to verify an insurer or agency
Before buying through any website or app, confirm who is selling you the policy and who will issue it:
- Find the licensed agency or insurer named in the site's footer, terms, or license page.
- Look up the agency or producer on your state insurance department's license search, or through the National Insurance Producer Registry (NIPR).
- Look up the insurer on your state insurance department's company search to confirm it is authorized in your state.
- Save the insurer's name and policy number once issued, since that is who handles claims.
A legitimate service will make this information easy to find. Be cautious if you cannot identify the licensed entity.
Sources
We checked the facts on this page against the sources below in October 2026. Plans, prices, and rules change, so confirm current terms before you buy.
- Medicare.gov: Special Needs Plans
- KFF: Medicare Advantage enrollment update (2026)
- CMS: Dual and LIS Special Enrollment Periods job aid (2025)
- Medicare.gov: Special Enrollment Periods
- Medicare.gov: Joining a health or drug plan
- Medicare.gov: When does Medicare coverage start?
- CMS: 2027 Medicare Advantage and Part D Star Ratings (Oct. 2026)
- PR Newswire via Finviz: Wellcare unveils 2027 Medicare offerings (Oct. 1, 2026)
- KFF: Medicare Advantage plan availability for 2027 (Oct. 2026)
- KFF: Medicare Advantage out-of-pocket limits
- Medicare.gov: Ready to buy a Medigap policy
- CMS: 2026 Medicare Parts A & B premiums and deductibles (Nov. 2025)
- CMS: Final CY 2026 Part D redesign program instructions
- Medicare.gov: Insulin
- Medicare.gov: Avoid late enrollment penalties
What to have ready for a Medicare review
These details help an agent quote accurately.
- Medicare card. Your Medicare number and Part A and B start dates.
- Doctors. Names of doctors and hospitals you want to keep.
- Prescriptions. Drug names, doses, and pharmacies.
- Current coverage. Any plan, employer, or Medicaid coverage you have.
- ZIP code. Plans differ by county.
Medicare Advantage SNPs FAQs
What does SNP stand for?
Special Needs Plan, a type of Medicare Advantage plan for specific groups.
Can anyone join a SNP?
No. You must meet the plan’s eligibility criteria and live in its service area.
Do SNPs cost more?
Costs vary. Many D-SNP members have Medicaid help with costs; compare plans in your area.
Can I leave a SNP?
Yes, during enrollment periods, and people with Medicaid have monthly options.
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Important information
Compensation. Links in the partner section of this page are sponsored, and Blake Insurance Group may be paid if you make a purchase. Sponsored placement does not affect the other information on this page.
Independent agency. Blake Insurance Group LLC is an independent insurance agency. Licensed insurance producer NPN 16117464. Licensed states: AZ, AL, TX, CA, NY, OH, FL, NC, VA, GA, OK, NM, IA, KS, MI, NE, SC, SD, WV, IL, NJ, PA, TN, and WA. Which insurance companies we can quote depends on our current appointments, the product, and your state. Mentioning a company on this page does not mean we represent it.
Medicare disclaimer. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE (TTY users 1-877-486-2048), or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.
Medicare figures. Costs, limits, and rules on this page were checked against CMS, Medicare.gov, and the other listed sources in October 2026. 2027 Part A and B amounts had not been announced. Confirm current figures at Medicare.gov.
Coverage terms. Descriptions are general. The policy contract controls what is covered.
Availability. Coverage, prices, and eligibility vary by company, state, and applicant, and are subject to underwriting. The issued policy controls.
Your next step
Request a quote, and a licensed agent will compare options available to us for your situation.
