Who is actually in a Special Needs Plan, and where is the room left?
8,315,532 people are enrolled in a Special Needs Plan — 6,469,576 in a D-SNP, 1,717,346 in a C-SNP and 128,610 in an I-SNP. D-SNPs have captured 54% of the country's dual-eligible population, but the state spread is enormous: Louisiana is at 74% and Oregon at 19%. That gap, not the national number, is where the opportunity sits.
D-SNP
C-SNP
I-SNP
Fully integrated (FIDE)
All three are Medicare Advantage plans restricted to a specific population, which lets them tailor benefits and networks in ways an open plan cannot.
D-SNP serves dual eligibles — people on both Medicare and Medicaid. It is by far the largest of the three at 78% of all SNP enrolment, and it is where essentially all the growth is.
C-SNP serves people with a qualifying chronic condition. In practice it is dominated by one bundle: cardiovascular disorders, chronic heart failure and diabetes account for the overwhelming majority of C-SNP members.
I-SNP serves people who are institutionalised or need an equivalent level of care at home. It is tiny by comparison — under 1.5% of SNP enrolment — but operationally the most intensive.
How integrated are the D-SNPs?
Integration status determines how far a D-SNP actually coordinates Medicare and Medicaid, and it is the axis CMS keeps tightening. Coordination-only plans do the least; fully integrated plans carry both benefits under one roof.
| Integration status | Enrolment | Share of D-SNP | Contracts | Plans |
|---|---|---|---|---|
| CO | 3,406,477 | 52.7% | 232 | 667 |
| HIDE | 2,303,427 | 35.6% | 132 | 314 |
| FIDE | 759,672 | 11.7% | 72 | 101 |
FIDE = fully integrated dual eligible. HIDE = highly integrated dual eligible. CO = coordination-only. Definitions and the applicable-integrated-plan flag come straight from the CMS report.
SNP enrolment across the states
Capture rate: how much of the dual population is in a D-SNP?
This is the number that matters for a market-entry decision. It divides D-SNP enrolment in the state (May 2026) by the dual-eligible population in that state (April 2026). A low rate with a large dual base is unclaimed ground; a high rate means the fight is over switching, not acquisition.
| State | D-SNP | C-SNP | I-SNP | Dual eligibles | Capture rate | Contracts |
|---|---|---|---|---|---|---|
| New York | 755,669 | 21,763 | 13,486 | 1,180,562 | 64.0% | 28 |
| Florida | 677,668 | 313,841 | 7,878 | 928,134 | 73.0% | 31 |
| California | 513,238 | 200,894 | 4,808 | 1,797,355 | 28.6% | 40 |
| Texas | 426,216 | 212,264 | 8,483 | 683,674 | 62.3% | 35 |
| Puerto Rico | 306,931 | 25,728 | 0 | 5,415 | — | 4 |
| Pennsylvania | 258,405 | 22,585 | 2,201 | 475,344 | 54.4% | 20 |
| Ohio | 255,694 | 23,908 | 8,723 | 402,562 | 63.5% | 19 |
| Georgia | 253,328 | 74,295 | 4,971 | 380,910 | 66.5% | 20 |
| North Carolina | 233,585 | 56,253 | 4,699 | 359,194 | 65.0% | 20 |
| Michigan | 166,863 | 26,203 | 2,736 | 338,248 | 49.3% | 22 |
| Louisiana | 164,723 | 33,643 | 1,712 | 223,850 | 73.6% | 14 |
| Alabama | 149,743 | 32,762 | 2,623 | 225,453 | 66.4% | 12 |
| Washington | 140,414 | 9,497 | 4,177 | 237,938 | 59.0% | 13 |
| Indiana | 133,840 | 17,214 | 5,892 | 222,265 | 60.2% | 12 |
| Tennessee | 133,616 | 9,911 | 620 | 236,173 | 56.6% | 12 |
| Arizona | 127,641 | 44,593 | 2,327 | 251,428 | 50.8% | 21 |
| Massachusetts | 117,903 | 2,487 | 0 | 374,447 | 31.5% | 12 |
| Virginia | 116,976 | 26,137 | 422 | 204,237 | 57.3% | 15 |
| Connecticut | 113,224 | 59 | 0 | 208,491 | 54.3% | 8 |
| Missouri | 108,101 | 33,621 | 3,113 | 189,954 | 56.9% | 17 |
| South Carolina | 106,027 | 79,064 | 1,356 | 174,819 | 60.6% | 11 |
| Mississippi | 105,825 | 28,930 | 733 | 163,247 | 64.8% | 15 |
| Kentucky | 102,849 | 10,754 | 1,024 | 179,170 | 57.4% | 15 |
| New Jersey | 98,738 | 1,961 | 1,173 | 231,704 | 42.6% | 7 |
| Wisconsin | 96,980 | 14,327 | 2,524 | 179,860 | 53.9% | 13 |
| Illinois | 81,758 | 81,910 | 3,106 | 394,426 | 20.7% | 17 |
| Arkansas | 80,643 | 44,298 | 2,704 | 132,305 | 61.0% | 13 |
| Colorado | 66,407 | 12,933 | 2,046 | 127,738 | 52.0% | 17 |
| Oklahoma | 62,885 | 30,976 | 668 | 119,016 | 52.8% | 14 |
| Maine | 51,228 | 1,007 | 0 | 105,625 | 48.5% | 8 |
| New Mexico | 44,232 | 10,511 | 0 | 45,780 | 96.6% | 11 |
| Iowa | 42,194 | 23 | 1,447 | 86,142 | 49.0% | 8 |
| Maryland | 40,970 | 1,236 | 507 | 155,956 | 26.3% | 9 |
| West Virginia | 39,577 | 0 | 1,592 | 83,399 | 47.5% | 7 |
| Minnesota | 34,805 | 5,657 | 0 | 138,638 | 25.1% | 10 |
| Nevada | 32,715 | 22,374 | 527 | 85,432 | 38.3% | 16 |
| Hawaii | 32,476 | 207 | 0 | 48,187 | 67.4% | 6 |
| Oregon | 32,099 | 22,922 | 2,172 | 169,911 | 18.9% | 14 |
| Rhode Island | 30,352 | 7,026 | 1,374 | 45,058 | 67.4% | 8 |
| Kansas | 24,101 | 8,101 | 872 | 69,234 | 34.8% | 10 |
| Nebraska | 23,564 | 231 | 638 | 43,874 | 53.7% | 10 |
| Utah | 21,827 | 16,777 | 192 | 34,889 | 62.6% | 11 |
| Idaho | 21,354 | 8,753 | 240 | 52,761 | 40.5% | 6 |
| District of Columbia | 16,813 | 0 | 0 | 34,310 | 49.0% | 2 |
| Delaware | 8,323 | 6,369 | 0 | 32,967 | 25.2% | 7 |
| Montana | 5,820 | 0 | 0 | 24,500 | 23.8% | 3 |
| South Dakota | 4,849 | 0 | 0 | 20,374 | 23.8% | 2 |
| North Dakota | 2,232 | 0 | 341 | 14,917 | 15.0% | 3 |
| Wyoming | 1,354 | 0 | 0 | 12,042 | 11.2% | 1 |
| New Hampshire | 0 | 1,580 | 0 | 30,707 | 0.0% | 1 |
Capture rate is not shown for Puerto Rico: Medicaid there operates under a block grant and the dual-eligible flag in the Medicare file does not describe the same population, which would put the ratio far above 100%.
Every SNP plan in the country
| Plan | Contract | Type | Integration | States | Enrolment |
|---|---|---|---|---|---|
| The plan explorer needs JavaScript. The complete plan list is available as CSV. | |||||
Who owns the SNP book?
| Parent brand (inferred) | SNP enrolment | Share | Contracts |
|---|---|---|---|
| UnitedHealth Group | 2,995,849 | 36.0% | 47 |
| Other / independent | 2,284,074 | 27.5% | 238 |
| Humana | 966,018 | 11.6% | 18 |
| CVS Health / Aetna | 818,988 | 9.8% | 33 |
| Elevance Health | 375,015 | 4.5% | 15 |
| Centene | 224,971 | 2.7% | 33 |
| Kaiser Permanente | 152,681 | 1.8% | 5 |
| Molina Healthcare | 138,516 | 1.7% | 17 |
| Devoted Health | 136,075 | 1.6% | 31 |
| SCAN | 86,382 | 1.0% | 6 |
| Alignment Healthcare | 82,286 | 1.0% | 5 |
| Blue Cross Blue Shield (other) | 50,098 | 0.6% | 6 |
| Highmark | 4,579 | 0.1% | 2 |
CMS publishes the legal contracting entity, not the parent brand — “Care Improvement Plus South Central Insurance Co.” and “Sierra Health and Life” are both UnitedHealth. The grouping above is inferred by keyword from the contract name and is offered as orientation, not as a filing-grade ownership map. Anything the keyword list does not recognise stays in Other / independent rather than being guessed at. The per-contract figures in the plan table above are exact.
What conditions do C-SNPs actually cover?
| Qualifying condition group | Enrolment | Share of C-SNP |
|---|---|---|
| Cardio DIS CHF and Diabetes | 1,586,341 | 92.4% |
| Cardio Disorders Diabetes | 57,975 | 3.4% |
| Chronic Lung Failure | 39,748 | 2.3% |
| Cardiovascular Disorders,Chronic Heart Failure,Diabetes Mellitus | 15,906 | 0.9% |
| Chronic kidney disease | 10,343 | 0.6% |
| Chronic Mental Health | 1,886 | 0.1% |
| Chronic Heart Failure | 1,496 | 0.1% |
| Chronic Mental Health,Substance use disorders and Chronic Mental Healt | 1,294 | 0.1% |
| Dementia | 1,065 | 0.1% |
| CKD and Post Renal Organ Transplantation | 640 | 0.0% |
The addressable population, county by county
SNP enrolment is published at plan level, so the finest geography CMS gives is the state. The dual-eligible population, though, is available per county — which is how you size a service area below the state line. That layer is on the county explorer, and the full county file is available as CSV: 3,199 counties, 12.0M duals, April 2026.
Where this comes from
SNP enrolment: CMS
Special Needs Plan Comprehensive Report, May 2026, plan-level tab
(SNP_REPORT_PART_17), 1,803 plan records totalling 8,315,532 enrollees. National
totals by type and by integration status are taken directly from the report's own summary tabs
rather than re-derived, so they tie to CMS exactly.
Dual-eligible population: CMS Medicare Monthly Enrollment, April 2026, county geography. The capture rate therefore compares a May enrolment figure to an April population figure — a one-month offset that moves the ratio by well under a point.
Two CMS suppression rules shape the tables. Individual plans with fewer than 11 enrollees are not named: the report rolls them into three Under-11 aggregate rows (125 enrollees in total — 60 D-SNP, 29 C-SNP, 36 I-SNP), and a further 70 named plan rows carry a suppressed enrolment shown here as zero. Both are counted in the national totals but carry no state, so they sit outside the state table. Separately, 44 plans operate across more than one state (139,065 enrollees, 1.7% of the total); their enrolment cannot be split between states, so they are excluded from the state table and the capture rate rather than arbitrarily assigned. The plan-level rows sum to exactly the CMS published total of 8,315,532.