Medicare Advantage

C-SNPs in San Jose for 2027: 12 chronic-condition plans and how to qualify

People in San Jose can choose from 36 Medicare Advantage plans for 2027, against 46 this year. 15 of this year’s plans are gone, 5 are new to Santa Clara County, and 31 that continue have changed their premium, deductible, plan type or name, 13 of them under a new name.

SAN JOSE, Calif. — If you live with a long-term health condition like diabetes, heart disease or a chronic lung problem, Medicare offers a type of Advantage plan built around that diagnosis. For 2027, Santa Clara County — the county San Jose sits in — will have 12 Chronic Condition Special Needs Plans (C-SNPs) to choose from, drawn from four carriers. The Annual Enrollment Period runs October 15 through December 7, 2026, with any change taking effect January 1, 2027.

What a C-SNP is, in plain terms

A Chronic Condition Special Needs Plan is a Medicare Advantage plan built for people living with a specific long-term illness. CMS lets insurers design these plans around one condition — or a group of related conditions, like diabetes and heart disease together — so the drug list, care coordination and provider network can line up with what people with that diagnosis typically need.

Like other Medicare Advantage plans, a C-SNP replaces Original Medicare while you are enrolled, and in Santa Clara County every C-SNP for 2027 includes Part D drug coverage. All 12 are HMOs.

The 2027 C-SNP lineup in Santa Clara County

For 2027, CMS lists 12 C-SNPs in the county. The table on this page shows every plan; by carrier, the counts are:

• Alignment Health Plan: 7 C-SNPs
• Astiva Health: 1 C-SNP
• Imperial Health Plan of California, Inc.: 2 C-SNPs (one new for 2027: Imperial Flex)
• SCAN Health Plan: 2 C-SNPs

Several Alignment Health Plan C-SNPs have been renamed for 2027 — for example, Alignment Health BreathEasy Plus 041 was previously Alignment Health BreathEasy. The underlying plan is still there; only the name changed. If you are already enrolled, your ANOC will spell out what, if anything, is different for your coverage.

For context, C-SNPs are one of three Special Needs Plan types. The county will also offer 3 Dual-Eligible SNPs (D-SNPs, for people with both Medicare and Medicaid) and 2 Institutional SNPs (I-SNPs, for people living in long-term care settings) in 2027.

Who can enroll, and how the diagnosis step works

A C-SNP is only open to people who have the qualifying chronic condition the plan is built for. Medicare requires that the diagnosis be confirmed by your provider — usually through a short form the plan sends to your doctor's office after you apply. If the provider does not confirm the condition within the time the plan allows, enrollment cannot go through.

A few things to know:

• You still need Medicare Part A and Part B, and you generally need to live in the plan's service area.
• The condition must be one the specific plan serves. Not every C-SNP covers the same conditions, and plan names do not always spell that out — ask the plan or check the Medicare Plan Finder.
• If you later no longer have the qualifying condition, you may lose eligibility for that plan, though Medicare gives you time to move to other coverage.

The Special Enrollment Period for chronic conditions

Most people can only change Medicare Advantage plans during set windows: the Annual Enrollment Period (October 15 – December 7) or the Medicare Advantage Open Enrollment Period (January 1 – March 31).

People with a qualifying chronic condition get an additional option. Medicare provides a Special Enrollment Period that lets you join a C-SNP you are eligible for outside the usual windows. In practice, that means you do not have to wait until next fall to switch into a C-SNP if your diagnosis qualifies. You can use this SEP once; after you are enrolled, future changes follow the normal rules.

If you are weighing a C-SNP during this fall's Annual Enrollment Period, the deadline for a January 1, 2027 start date is December 7, 2026.

How to decide if a C-SNP fits

C-SNPs are not automatically a better or worse choice than a general Medicare Advantage plan — they are a different design. A few questions worth asking before you switch:

• Does my doctor accept this plan? C-SNPs are HMOs in Santa Clara County, which generally means in-network care and referrals.
• Are my medications on the plan's drug list, and at what tier?
• How does the plan coordinate care for my condition — care manager, specialist access, home visits?
• What are the plan's total costs for me in a typical year, not just the premium?

The Medicare Plan Finder at medicare.gov lets you enter your prescriptions and preferred providers to compare plans side by side. You can also call 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day, seven days a week.

What is confirmed for 2027 — and what is not

CMS has confirmed several Part D figures for 2027: the Part D out-of-pocket cap rises to $2,400 (up from $2,100 in 2026), and the Part D maximum deductible rises to $700 (up from $615 in 2026). The 2027 Part B standard premium, Part B deductible and IRMAA income brackets have not been announced yet; CMS typically publishes them in the fall, usually in November.

For Santa Clara County overall, 2027 will bring 15 Medicare Advantage plans not returning, 5 new plans and 13 renamed plans. If your current plan is in one of those groups, your ANOC — mailed by the end of September — explains what changes.