Medicare Advantage

Dual Special Needs Plans in Philadelphia for 2027: who qualifies and how to switch

People in Philadelphia can choose from 98 Medicare Advantage plans for 2027, against 97 this year. Twelve of this year’s plans are gone, 13 are new to Philadelphia County, and 39 that continue have changed their premium, deductible, plan type or name, 9 of them under a new name.

PHILADELPHIA — For the roughly 300,000 Philadelphians who hold both Medicare and Medical Assistance (Pennsylvania's Medicaid), the plan lineup for 2027 is set. In Philadelphia County, 20 Dual Special Needs Plans (D-SNPs) will be offered next year, from 11 carriers — and if you qualify, you do not have to wait for the fall Annual Enrollment Period to make a move.

D-SNPs are a type of Medicare Advantage plan built for people who have both programs. They include Part D drug coverage and are designed to coordinate with Medicaid benefits. Because dual-eligible members have more flexibility than most Medicare beneficiaries, this article walks through who qualifies, how often you can change plans, and how to confirm what level of Medicaid you have.

What's changing for 2027 in Philadelphia County

Philadelphia is in Philadelphia County, where Medicare Advantage availability is set. For 2027, the D-SNP count rises to 20 plans. Two are new for next year — Aetna Medicare Full Dual Care (HMO D-SNP) and Humana Dual Select H6622-103 (HMO D-SNP) — and a handful have been renamed, including Aetna Medicare Dual Care (HMO D-SNP), Wellcare PA Health & Wellness Dual Liberty Sync (HMO-POS D-SNP), Wellcare PA Health & Wellness Dual Select (HMO-POS D-SNP), and UHC Dual Advantage PA-V1 (HMO-POS D-SNP).

The full roster appears in the table below. The 11 carriers offering D-SNPs in the county are Aetna (CVS Health), Centene (WellCare), Devoted Health, Geisinger Gold, HealthSpring, Highmark Wholecare Medicare Assured, Humana, Jefferson Health Plans, UnitedHealthcare, UPMC for Life Complete Care, and VISTA Health Plan Inc.

If you are already in a D-SNP, read the Annual Notice of Change (ANOC) your plan mailed in September. It spells out what is different for your plan in 2027, including any name change.

Who qualifies: full vs. partial dual eligibility

To enroll in any D-SNP you need both Medicare and Medicaid. In Pennsylvania, Medicaid for seniors and people with disabilities is called Medical Assistance, and the state's Department of Human Services decides your level. The common categories:

• Full dual eligible (FBDE): You get the complete Medical Assistance benefit package in addition to Medicare.
• QMB (Qualified Medicare Beneficiary): Medicaid pays your Part A and B premiums and, generally, your Medicare cost-sharing.
• QMB+: QMB plus full Medicaid benefits.
• SLMB (Specified Low-Income Medicare Beneficiary) and SLMB+: Medicaid pays the Part B premium; SLMB+ also includes full Medicaid.
• QI (Qualifying Individual): Medicaid pays the Part B premium only.

Different D-SNPs are designed for different categories — some only accept members with full benefits, others accept partial dual categories too. That is why confirming your exact level matters before you pick a plan.

How often a dual-eligible person can change plans

Most people with Medicare can only change plans during the Annual Enrollment Period (Oct. 15 – Dec. 7, 2026, for coverage starting Jan. 1, 2027) or the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31). If you have Medicaid or Extra Help, you get more opportunities.

Under current rules, dual-eligible members have a monthly Special Enrollment Period that lets you, once per calendar quarter in the first three quarters of the year, make one of these changes:

• Join an integrated D-SNP that aligns your Medicare and Medicaid coverage with the same company, or
• Drop a Medicare Advantage plan and return to Original Medicare, pairing it with a standalone Part D drug plan.

There is also a separate SEP any time your Medicaid status changes — for example, if you newly qualify, lose eligibility, or move between full and partial dual categories.

CMS periodically updates these rules, so confirm the current timing with 1-800-MEDICARE (TTY 1-877-486-2048) before you act.

How to confirm your eligibility

Three quick checks will tell you where you stand:

1. Your Medicaid level: Call the Pennsylvania Department of Human Services or log in to COMPASS (compass.state.pa.us) to see your current category — full, QMB, SLMB, SLMB+, or QI. 2. Your Medicare status: Sign in at medicare.gov to verify your Parts A and B effective dates and any current plan enrollment. 3. Which D-SNPs you can join: Use the Medicare Plan Finder at medicare.gov or call 1-800-MEDICARE. A plan can only enroll you if your Medicaid category matches what the plan accepts.

Program-level numbers to keep in mind for 2027

A D-SNP includes Part D, so the drug-benefit rules Medicare sets each year matter. CMS has confirmed these figures for 2027:

• Part D out-of-pocket cap: $2,400 in 2027 (up from $2,100 in 2026).
• Part D maximum deductible: $700 in 2027 (up from $615 in 2026).
• Part D national base beneficiary premium: $41.33 — a formula input, not a price any plan charges.

For many dual-eligible members, Extra Help (the Low-Income Subsidy) covers most or all drug costs, so these caps are a ceiling you are unlikely to hit. The 2027 Part B standard premium, Part B deductible, and IRMAA income brackets have not been announced yet; CMS typically publishes them in November.