26-1291 2027 Medicare Advantage and Special Needs Plan Updates: What You Need to Know
Date: 11/03/26
County changes, plan terminations and member impacts
Starting January 1, 2027, key updates will impact Medicare Advantage (MA), Dual Special Needs Plans (D-SNPs) and Chronic Special Needs Plans (C-SNPs). This guide outlines county-specific transitions, benefit changes and operational updates to help physicians, practitioners and other providers support members effectively.
What you need to do
Because plan benefits are updated annually, you should:
- Verify coverage before services are rendered.
- Review each Plan’s Annual Notice of Change on the Plan Benefit Member Materials website.
- Refer to the Member Handbook/Evidence of Coverage for a complete list of benefits.
County-level plan changes
Plan segmentation (H3561-008)
Wellcare Health Net Dual Align (HMO D-SNP), H3561-008, will segment into two separate plan benefit packages based on county of residence. Members will be reassigned to the applicable new plan by the Plan – no action is required from members.
- Los Angeles County (H3561-010-001)
Members residing in Los Angeles County will move to this new Plan Benefit Package (PBP). - Remaining service area (H3561-010-002)
Members in Amador, Calaveras, Inyo, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties will move to this new PBP.
Plan name changes
The following plans are being renamed, effective January 1, 2027 (no change to counties served or benefits):
- H0562-012 and H0562-097: Wellcare Low Premium (HMO) → Wellcare Low Premium Focus (HMO)
- H3561-009: Wellcare Dual Liberty (HMO D-SNP) → Wellcare Health Net Dual Liberty (HMO D-SNP)
Plan terminations
Wellcare Low Premium (HMO) MA Plan H0562-133 will be discontinued.
- Affects members in Amador and Yolo counties.
How this affects you and members
- Members affected by the plan segmentation will receive new ID cards.
- Eligibility files will reflect new member assignments.
- Affected members will be disenrolled from the above plans, effective December 31, 2026.
- Members were notified via mail in early October about their Medicare options.
C-SNP enrollment
For new enrollees in the C-SNP plan:
- Verify qualifying chronic conditions to complete enrollment.
- Members will designate which physician, practitioner and other provider(s) can confirm their condition.
- The Plan will contact the physician, practitioner or other provider for a verbal or faxed attestation within three business days.
Operational updates that affect D-SNP members
Expansion of SSBCI benefits to Wellcare CalViva Health Dual Align Members (H351-007)
Since 2026, Value-Based Insurance Design (VBID) benefits have transitioned to Special Supplemental Benefits for the Chronically Ill (SSBCI). The benefit is now being offered to D-SNP members who have Wellcare CalViva Health Dual Align plans. Members will need to meet specific clinical criteria to qualify for the additional benefits.
What you need to do:
- Ensure accurate diagnosis coding on claims.
- Respond promptly to member letters requesting eligibility verification.
Eligible members may receive:
- Food and produce
- Gas pay-at-pump
- General supports for living
- Home structural modifications
- Indoor air quality services
- Meals
- Non-medical transportation
- Pest control
- Safety devices and modifications
- Utility and rent/mortgage assistance
Qualification process:
- Automated via diagnosis codes on claims.
- New members may require provider-supported attestation.
New dental vendor
Liberty Dental Plan will become the dental benefits administrator for all Wellcare By Health Net Medicare Advantage, D-SNP and C-SNP plans, effective January 1, 2027, replacing the current dental vendors (DBP for MA plans; Delta Dental for D-SNP/C-SNP plans).
- Dental providers should confirm network participation with Liberty Dental Plan ahead of the transition to avoid claims disruption.
- Members will receive updated dental ID information; existing Delta Dental/DBP referrals and authorizations will not carry over automatically.
Access D-SNP/C-SNP resources
View the D-SNP/C-SNP provider resource pages at the links below for more information, including FAQs, trainings and more.
2027 Medicare plans and D-SNPs/C-SNPs by county
County | Products | County | Products |
|---|---|---|---|
Amador | H3561-010-002-Wellcare Health Net Dual Align (D-SNP) | Kings | H3561-007-Wellcare CalViva Health Dual Align (D-SNP) |
Calaveras | H3561-010-002-Wellcare Health Net Dual Align (D-SNP) | Los Angeles | H0562-092-Wellcare Specialty Simple (C-SNP) H0562-125-Wellcare Simple Focus (HMO) PSP1 H0562-136-Wellcare Low Premium (HMO) H3561-010-001-Wellcare Health Net Dual Align (D-SNP) H5087-005-Wellcare Simple (HMO) H5087-032-Wellcare Giveback (HMO) |
Fresno | H3561-007-Wellcare CalViva Health Dual Align (D-SNP) | Madera | H3561-007-Wellcare CalViva Health Dual Align (D-SNP) |
Imperial | H0562-012-Wellcare Low Premium Focus (HMO) PSP1 H0562-137- Wellcare Low Premium (HMO) H3561-009-Wellcare Health Net Dual Liberty | Mono | H3561-010-002-Wellcare Health Net Dual Align (D-SNP) |
Orange | H0562-092-Wellcare Specialty Simple (C-SNP) H0562-125-Wellcare Simple Focus (HMO) PSP1 H0562-136-Wellcare Low Premium (HMO) H3561-009-Wellcare Health Net Dual Liberty H5087-005-Wellcare Simple (HMO) | ||
Inyo | H3561-010-002-Wellcare Health Net Dual Align (D-SNP) | ||
Kern | H0562-092-Wellcare Specialty Simple (C-SNP) H3561-009-Wellcare Health Net Dual Liberty | Placer | H3561-009-Wellcare Health Net Dual Liberty |
Riverside | H0562-092-Wellcare Specialty Simple (C-SNP) H0562-126-Wellcare Simple Focus (HMO) PSP1 H0562-137- Wellcare Low Premium (HMO) H3561-009-Wellcare Health Net Dual Liberty | San Francisco | H0562-097-Wellcare Low Premium Focus (HMO) PSP1 H0562-138-Wellcare Specialty Simple Focus (C-SNP) PSP1 H3561-009-Wellcare Health Net Dual Liberty (D-SNP) |
Sacramento | H3561-010-002-Wellcare Health Net Dual Align (D-SNP) | San Joaquin | H3561-010-002-Wellcare Health Net Dual Align (D-SNP) H5087-035-Wellcare Simple (HMO) |
San Bernardino | H0562-092-Wellcare Specialty Simple (C-SNP) H0562-126-Wellcare Simple Focus (HMO) PSP1 H0562-137- Wellcare Low Premium (HMO) H3561-009-Wellcare Health Net Dual Liberty | Stanislaus | H3561-010-002-Wellcare Health Net Dual Align (D-SNP) |
San Diego | H0562-012-Wellcare Low Premium Focus (HMO) PSP1 H0562-092-Wellcare Specialty Simple (C-SNP) H0562-137- Wellcare Low Premium (HMO) H3561-009-Wellcare Health Net Dual Liberty | Tulare | H3561-010-002-Wellcare Health Net Dual Align (D-SNP) |
Tuolumne | H3561-010-002-Wellcare Health Net Dual Align (D-SNP) |
1PSP= Provider Specific Plan
2027 Medicare and Medicare D-SNP codes with plan name and service area
The table below shows the 2027 Wellcare By Health Net Medicare and Medicare D-SNPs and service areas:
2027 | 2027 Plan name | Service area | 2027 Plan codes |
|---|---|---|---|
H0562-012 | Wellcare Low Premium Focus (HMO) | Imperial, San Diego | NWW |
H0562-092 | Wellcare Specialty Simple (HMO C-SNP) | Kern, Los Angeles, Orange, Riverside, | NWU |
H0562-097 | Wellcare Low Premium Focus (HMO) | San Francisco | NWR |
H0562-125 | Wellcare Simple Focus (HMO) | Los Angeles, Orange | NWS |
H0562-126 | Wellcare Simple Focus (HMO) | Riverside, San Bernardino | NWT |
H0562-136 | Wellcare Low Premium (HMO) | Los Angeles, Orange | NWX |
H0562-137 | Wellcare Low Premium (HMO) | Imperial, Riverside, San Bernardino, | NWY |
H0562-138 | Wellcare Specialty Simple Focus | San Francisco | NWV |
H3561-007 | Wellcare CalViva Health Dual Align | Fresno, Kings, Madera | NWQ |
H3561-009 | Wellcare Dual Liberty (HMO D-SNP) | Imperial, Kern, Orange, Placer, Riverside, San Bernardino, San Diego, San Francisco | NWP |
H3561-010-001 | Wellcare Health Net Dual Align | Los Angeles | NWN |
H3561-010-002 | Wellcare Health Net Dual Align | Amador, Calaveras, Inyo, Mono, Sacramento, San Joaquin, Stanislaus, Tulare, Tuolumne | NWO |
Need help? Contact us
If you have questions, contact 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 and Practitioners, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.