The three kinds of special needs plans
| Type | Who can join | How eligibility is checked |
|---|---|---|
| D-SNP (dual eligible) | People with Medicare and NC Medicaid, which can include a Medicare Savings Program (MQB), as the plan's contract with NC Medicaid allows. | The plan confirms your Medicaid with the state. |
| C-SNP (chronic condition) | People with a severe or disabling chronic condition the plan serves, such as diabetes, chronic heart failure or end-stage renal disease. | Your doctor, physician assistant or nurse practitioner must confirm the condition. |
| I-SNP (institutional) | People living, or expected to live, 90 days or more in a nursing home or similar facility, or needing that level of care at home. | An assessment of your care needs. |
You still need Part A and Part B and must live in the plan's service area. Every SNP includes Part D drug coverage.
Special needs plans in North Carolina for 2027
CMS's CY2027 Landscape file lists 57 special needs plans of all three types in North Carolina, and every county has some. The number varies by county:
D-SNPs work differently here
Federal rules sort D-SNPs by how much Medicaid they include. In North Carolina, every D-SNP for 2027 (as for 2026) is coordination-only: it covers your Medicare and coordinates with NC Medicaid, but it doesn't cover your Medicaid benefits. CMS's data show no fully or highly integrated D-SNPs in the state. Most people with Medicare and full NC Medicaid get their Medicaid through NC Medicaid Direct, so joining a D-SNP doesn't change who pays for Medicaid services such as CAP/DA waiver care. Each D-SNP must have a contract with NC Medicaid.
PACE is North Carolina's option that combines Medicare and Medicaid in one program, for people 55 and older who need nursing-home-level care and live in a PACE area. NC Medicaid lists 11 PACE organizations. See D-SNPs in North Carolina and D-SNP vs. Original Medicare and NC Medicaid.
To compare special needs plans from the companies they work with, you can request a call from a licensed insurance agent.
Related questions
Can I be denied Medicare Advantage in North Carolina?
Who a plan must accept, and SNP limits.
How many Medicare Advantage plans are in NC for 2027?
Statewide and county counts.
How do I choose a Medicare plan in North Carolina?
Steps to compare your options.
Sources
- Medicare.gov — Special Needs Plans (SNP)
- eCFR — 42 CFR 422.52, eligibility for special needs plans (verification, deemed continued eligibility)
- eCFR — 42 CFR 422.2, definitions (special needs individual, FIDE and HIDE SNPs)
- CMS — Medicare Advantage Landscape files, contract years 2026 and 2027 (SNP counts and integration status)
- NC Medicaid — Medicaid Health Plans and Programs (NC Medicaid Direct)
- NC Medicaid — Program of All-Inclusive Care for the Elderly (PACE)
More questions in this guide
- Can I be turned down for a Medicare Advantage plan in North Carolina?
- How do I choose a Medicare plan in North Carolina?
- How many Medicare Advantage plans are in North Carolina for 2027?
- Is Medicare Advantage available in every North Carolina county?
Part of the guide: Medicare Advantage in North Carolina · All questions
Frequently asked questions
Do special needs plans include drug coverage?
Yes. Every special needs plan must include Part D prescription drug coverage.
What happens if I stop qualifying for my special needs plan?
If the plan expects you to qualify again within 6 months, for example after a Medicaid renewal, it must keep you enrolled for at least 30 days and up to 6 months (42 CFR 422.52(d)). After that, it ends your enrollment and you get a special enrollment period to choose other coverage.
Can I join a C-SNP for diabetes or heart failure?
If a C-SNP for your condition is sold in your county and your doctor confirms the condition, yes. The plan must verify the condition with your doctor, physician assistant or nurse practitioner, and if it can't confirm it by the end of your first month, it ends your enrollment at the end of the second.
Medicare in your North Carolina county
Plans, local agents and help, county by county: Wake · Mecklenburg · Guilford · Forsyth · Durham · Cumberland · Buncombe · Union · Johnston · Cabarrus · New Hanover · Gaston · Onslow · Iredell · Alamance · Pitt · Davidson · Brunswick · Catawba · Rowan · All 100 counties →
