Medicare Advantage

Have a chronic condition? Durham C-SNP rules, 2027

For 2027, Durham is looking at 69 Medicare Advantage plans: 6 new, 11 gone since 2026, and 25 still here but changed on premium, deductible, plan type or name, 9 of them under a new name. Below, how the lineup shifted in Durham County and what to compare, with no plan ranked or recommended.

DURHAM, N.C. — If you live with a long-term health condition like diabetes or heart disease, Medicare offers a type of plan designed around you. For 2027, Durham County residents will have three Chronic Condition Special Needs Plans — known as C-SNPs — to consider during the Annual Enrollment Period that runs October 15 through December 7, 2026. Any choice you make in that window takes effect January 1, 2027.

C-SNPs are a specific kind of Medicare Advantage plan. They are open only to people whose doctor confirms a qualifying chronic condition, and they come with their own enrollment rules. Here is how they work in Durham for 2027, and what to think about before you choose.

What is a C-SNP and how does it work in Durham for 2027?

A Chronic Condition Special Needs Plan is a Medicare Advantage plan limited to people with one or more specific chronic conditions, such as diabetes, chronic heart failure or a cardiovascular disorder. Each C-SNP is built around the condition it serves, which usually means the drug list, the care coordination and the network of specialists are chosen with that condition in mind.

Like other Medicare Advantage plans, a C-SNP replaces how you get your Part A and Part B benefits and, in Durham's case, all three C-SNPs for 2027 also include Part D drug coverage. You still pay your Part B premium, and the plan sets its own costs and rules on top of that.

Which C-SNPs are offered in Durham County for 2027?

Durham is in Durham County, where three C-SNPs are offered for 2027 out of 69 Medicare Advantage plans total. The other Special Needs Plans in the county are 20 Dual Eligible SNPs (D-SNPs, for people with both Medicare and Medicaid) and 5 Institutional SNPs (I-SNPs, for people in nursing facilities).

The three C-SNPs available in Durham County for 2027, in alphabetical order by carrier, are:

• Humana Gold Plus - Diabetes and Heart (HMO C-SNP) — Humana
• Liberty Medicare Advantage (HMO C-SNP) — Liberty Medicare Advantage
• UHC Complete Care NC-28 (HMO-POS C-SNP) — UnitedHealthcare

The table below lists every Medicare Advantage plan in Durham County, including these C-SNPs, so you can see the full landscape. Only the Humana plan states a condition in its name (diabetes and heart). For the other two, you will need to check the plan's materials to see exactly which conditions qualify.

Who qualifies for a Durham C-SNP, and how do you prove it?

You can only enroll in a C-SNP if a provider confirms you have a qualifying chronic condition that the plan is built to serve. CMS maintains the list of conditions that qualify — common ones include diabetes, chronic heart failure, cardiovascular disorders, chronic lung disorders and end-stage renal disease — and each plan chooses which of those it covers.

The plan will ask for a verification form that your doctor signs. If your provider cannot confirm the diagnosis within the plan's time window, your enrollment can be cancelled. This is different from a regular Medicare Advantage plan, where anyone with Medicare Parts A and B in the service area can join.

When can you enroll in a C-SNP in Durham?

You have two paths. First, the Annual Enrollment Period runs October 15 through December 7, 2026, and coverage starts January 1, 2027. If you do nothing, your current plan simply renews — read the Annual Notice of Change (ANOC) your plan sent to see what is different for 2027.

Second, a qualifying chronic diagnosis gives you a Special Enrollment Period (SEP). That means if you are newly diagnosed with a condition one of these plans serves, you do not have to wait for fall — you can enroll once your provider confirms the diagnosis. You generally get one chance to use this SEP to join a C-SNP for your condition. If you later lose eligibility (for example, your condition is no longer confirmed), the plan gives you a grace period to switch to another Medicare option.

What should Durham residents compare before choosing a C-SNP?

Because every C-SNP is designed around a condition, the fit matters more than with a general Medicare Advantage plan. A few things to check on medicare.gov or in each plan's Evidence of Coverage:

• Whether your specific diagnosis is on the plan's qualifying list.
• Whether your doctors and specialists are in the plan's network.
• Whether the medicines you take are on the plan's formulary and at what tier.
• How the plan coordinates care — many C-SNPs assign a care team or care manager.
• The 2027 Part D figures that apply to any plan with drug coverage: the out-of-pocket cap is $2,400 (up from $2,100 in 2026), and the maximum deductible is $700 (up from $615 in 2026).

CMS announces the 2027 Part B standard premium, Part B deductible and IRMAA income brackets later in the fall, usually in November. Those apply to everyone on Medicare, not just C-SNP members.

What is changing in Durham's Medicare Advantage lineup for 2027?

Across all Medicare Advantage plans in Durham County, 11 plans are not returning for 2027, 6 are new and 9 have been renamed. Your plan's ANOC spells out the specifics for your coverage. If your plan is one of the ones leaving, you will get a non-renewal notice and a Special Enrollment Period to pick a new plan.