25-1184sum Summary Update: 2026 Medicare Advantage and D-SNP Updates: What Providers Need to Know
Date: 11/13/25
Key highlights: County changes, plan terminations and member impacts
Refer to the complete update, 25-1184, 2026 Medicare Advantage and D-SNP Updates: What Providers Need to Know (PDF).
Effective January 1, 2026, key information includes:
- County-level plan transitions
Dual Eligible Special Needs Plan (D-SNP) members will be moved
to new plan benefit packages based on residence, including aligned and non-aligned transitions. - New coverage areas
D-SNP expansion to Inyo and Mono counties; new Chronic Special Needs Plan (C-SNP) is available in San Francisco for members with qualifying chronic conditions. - Plan and county terminations
Several Medicare Advantage plans and county offerings will be discontinued, impacting member enrollment and eligibility. - C-SNP enrollment support
Providers must verify chronic conditions for new enrollees. Attestation required within three business days. - Value-based Insurance Design benefits transition to Special Supplemental Benefits for the Chronically Ill.
D-SNP members may qualify for new supplemental benefits based on clinical criteria and
diagnosis codes. - Non-emergency medical transportation (NEMT)
NEMT will be covered through Medi-Cal. A completed Physician Certification Statement form is required for enhanced transport. - Annual benefit changes
Providers should review the Annual Notice of Change and Member Handbook to confirm
coverage details. - 2026 plans by county
A table listing the 2026 Medicare plans and D-SNPs/C-SNPs products in different counties.
Provider action items
- Watch for new member ID cards and updated eligibility files.
- Ensure accurate diagnosis coding on claims.
- Respond promptly to Plan outreach and member verification requests.
Additional information
If you have questions regarding the information contained in this update, call the Provider Services Center at:
- Individual and employer group: 800-929-9224
- Medicare supplemental: 800-641-7761
- Behavioral health providers: 844-966-0298
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.