Utah · Medicare Advantage · Special Needs Plans for diabetes and heart disease, 2027

Medicare C-SNPs in Utah for 2027: Diabetes & Heart Plans

If you have diabetes, heart failure, or a heart or circulation disorder such as atrial fibrillation or coronary artery disease, there is a kind of Medicare Advantage plan built only for people like you, and Utah will have 5 of them in 2027, up from 3. CMS's new plan file shows every one at a $0 plan premium. We put each plan in one table, compared it with 2026, counted how many Utahns are already in one, and set the county map beside the CDC's county diabetes and heart disease rates.

Utah Retirement Income Data Desk

Reviewed by Brian Penner, Retirement income & long-term care planner · Published October 1, 2026

A Chronic Condition Special Needs Plan, or C-SNP, is a Medicare Advantage plan that CMS allows to limit its membership to people with specific severe or disabling chronic conditions, and to build its benefits, network, drug list and care coordination around those conditions. For 2027 Utah has 5 of them, all for the diabetes, heart failure and cardiovascular group, all with a $0 plan premium, and all with Part D drug coverage built in, as every SNP must have. For a Utah retiree with one of those diagnoses, that is 2 more choices than this year, but it is still a short list, it covers only part of the state, and it is a Medicare Advantage plan with everything that implies: a network, prior authorization rules, and an out-of-pocket limit that can be as high as $9,850. Whether one of these plans fits is a question about your doctors and your drugs, not about the premium.

What is a Chronic Condition Special Needs Plan?

Medicare.gov describes a Special Needs Plan as a Medicare Advantage plan that provides benefits and services to people with specific severe and chronic diseases, certain health care needs, or who also have Medicaid. There are three kinds. A D-SNP is for people with both Medicare and Medicaid; we cover Utah's in our guide to dual-eligible plans. An I-SNP is for people who live in, or need the level of care given in, a nursing facility. A C-SNP is for people with a qualifying chronic condition. For 2027 the CMS Utah fact sheet counts 18 Special Needs Plans among the state's 51 Medicare Advantage plans; by our reading of the plan file that is 11 D-SNPs, 2 I-SNPs and 5 C-SNPs.

Four things, from Medicare.gov and CMS's manual for these plans, separate a C-SNP from an ordinary Medicare Advantage plan:

• Membership is limited. You can join only if you have a condition the plan serves, and you can stay enrolled only as long as you continue to have it.
• Part D is required. Every SNP must provide Medicare drug coverage, because, in CMS's words, special needs individuals must have access to prescription drugs to manage and control their conditions.
• Care coordination is required. Medicare.gov says all SNPs give care coordination services and tailor their benefits, provider choices and drug lists to the groups they serve. Each plan has a CMS-reviewed Model of Care describing how it does that.
• Everything else is Medicare Advantage. A C-SNP is an HMO or PPO, covers everything Part A and Part B cover, has a network, can require referrals and prior authorization, and has an in-network out-of-pocket limit. Medicare.gov adds that a plan cannot charge more than Original Medicare for certain services, including chemotherapy, dialysis and skilled nursing facility care, and that a prior approval it gives for a treatment must stay valid for as long as the treatment is medically necessary.

Which chronic conditions qualify?

CMS keeps a list of 15 SNP-specific chronic conditions, recommended by a panel of clinicians from the CDC, the Agency for Healthcare Research and Quality and CMS, and written into the Medicare Managed Care Manual. The full list: chronic alcohol and other drug dependence; certain autoimmune disorders; cancer, excluding pre-cancer conditions; certain cardiovascular disorders; chronic heart failure; dementia; diabetes mellitus; end-stage liver disease; end-stage renal disease requiring dialysis; certain severe hematologic disorders; HIV/AIDS; certain chronic lung disorders; certain chronic and disabling mental health conditions; certain neurologic disorders; and stroke. A company can build a C-SNP around one condition, around one of five CMS-approved groups of related conditions, or around its own combination.

Every Utah C-SNP for 2027 is built on the same CMS-approved group, number four on the list: diabetes mellitus, chronic heart failure and cardiovascular disorders. That is not a Utah peculiarity. Counting the national file, 653 of the 744 C-SNPs listed anywhere for 2027, 87.8%, use that grouping; the next most common types, chronic kidney disease and chronic lung disorders, have no Utah plan at all. Two details in the manual matter for whether you qualify:

• You need only one. For a plan approved on a CMS group, the manual says enrollees need to have only one of the qualifying conditions. A person with diabetes and no heart disease qualifies; so does a person with heart failure and no diabetes.
• "Cardiovascular disorders" is a defined term. On CMS's list it is limited to cardiac arrhythmias, coronary artery disease, peripheral vascular disease and chronic venous thromboembolic disorder. So atrial fibrillation qualifies, a past heart attack or stent generally does, and so does peripheral artery disease. High blood pressure or high cholesterol on their own are not on the list, even though they are common and are treated by the same doctors.

Chronic lung disease is the gap most likely to matter for Utahns. The CDC estimates COPD among adults above the national 6.2% in 15 of Utah's 29 counties, nearly all of them rural, and Utah's Medicare population rents home oxygen at about 2.7 times the national rate, as we found in our medical equipment guide. There is no lung C-SNP in Utah for 2027; a person whose only qualifying diagnosis is emphysema or pulmonary fibrosis would look at ordinary Medicare Advantage plans or at Original Medicare with a Medigap policy instead.

What are the 5 C-SNPs in Utah for 2027?

The table lists every plan in the CMS file for Utah with SNP type "Chronic or Disabling Condition," with 2026 figures for the same contract and plan ID. Sorted by number of counties.

Every Chronic Condition SNP listed for Utah in the CMS CY2027 Landscape file, release 202609, with 2026 figures for the same contract and plan ID from the CY2026 file — cms.gov. The plan listed as "Choice Enhanced" for 2027 was listed as "Choice Premium" in 2026 under the same ID. Members: CMS Monthly Enrollment by Contract/Plan/State/County, September 2026 — cms.gov; county-plan counts of 10 or fewer are withheld, which affected 9 cells for the two smaller plans. This is a factual listing from a CMS file, not a ranking or a recommendation; copayments, networks, supplemental benefits and drug lists are not in the file. 2027 Star Ratings are due on or around October 8, 2026. We do not offer every plan available in your area. CMS notes that landscape data can change as contracts are finalized.

Sources: CMS CY2026 and CY2027 Landscape files; CMS Monthly Enrollment by Contract/Plan/State/County, September 2026 (our tabulation); Medicare.gov, Medicare costs — medicare.gov.

Three things changed between the two files. First, the price: the two Devoted plans charged $37.60 a month in 2026 and charge $0 for 2027, so for the first time every Utah C-SNP has no plan premium. Second, the map: Devoted's plans go from 6 counties to 11, adding Duchesne, Juab, Rich, Utah and Weber, and Humana enters with a plan in 4 Wasatch Front counties; the UnitedHealthcare plan keeps the same 25. Third, the ceilings: all three continuing plans raised their in-network out-of-pocket limit, the two Devoted plans by $550 and $600 and the UnitedHealthcare plan by $300, and that plan's Part D deductible goes from $440 to $685. The federal ceiling on in-network out-of-pocket limits rises from $9,250 to $9,850 for 2027, and one Utah C-SNP sits exactly at it.

How much does a C-SNP cost in Utah?

The premium column is the least informative one in the table, because it is $0 across the board. What varies is the exposure: the most you can be asked to pay in a year for in-network Part A and Part B services. For 2027 CMS allows a plan to set that limit anywhere up to $9,850, and it labels limits at or under $4,450 "lower" and limits at or under $7,150 "intermediate." No Utah C-SNP reaches the lower tier.

In-network maximum out-of-pocket amount for 2027, CMS CY2027 Landscape file. The federal maximum for 2027 is $9,850 — cms.gov. PPO plans also have a higher combined limit for in- and out-of-network care that is not shown.

Three other lines belong in the arithmetic. The Part B premium, $202.90 a month in 2026, is paid to Medicare in every plan; the 2027 figure is normally announced in November. The Part D deductible runs from $461 to $700 across the five plans, and spending on covered drugs is capped at $2,400 in 2027 in every Medicare drug plan; insulin is capped at $35 a month, which matters in a plan built for diabetes, and we cover the rest in our diabetes costs guide. And the copayments for the visits, tests and specialists a person with heart disease or diabetes actually uses, an endocrinologist, a cardiologist, an echocardiogram, a podiatrist, lab work every three months, are set by each plan and are not in the file; they are in the plan's Summary of Benefits and on Medicare Plan Finder.

A C-SNP may also offer extra benefits aimed at its condition, such as an allowance for over-the-counter supplies, meals after a hospital stay, or transportation to appointments, and some advertise a Part B premium reduction. Those are real benefits, but they are the plan's to change each year, and none of them changes the ceiling.

How many Utahns are in a C-SNP?

More than the short plan list suggests. CMS publishes how many people are in each plan in each county every month. In September 2026, at least 17,329 Utahns were in one of the state's three C-SNPs, and 17,156 of them, 99.0%, were in a single plan, the UnitedHealthcare HMO-POS that covers 25 counties. The two Devoted plans had at least 123 and 50 members in the counties CMS does not suppress. Measured against the 258,437 Utahns in the Medicare Advantage plans on the 2026 list, C-SNP members are about 6.7% of the total, a little above the national 6.1%. For scale, Utah's D-SNPs had 21,219 members in the same file, and all Special Needs Plans together 38,704.

Our tabulation of CMS Monthly Enrollment by Contract/Plan/State/County, September 2026, for the plan IDs on the CY2026 Utah landscape list; county-plan counts of 10 or fewer are withheld, so the C-SNP and D-SNP rows are slightly understated. CMS's June 2026 Medicare Monthly Enrollment counts 269,226 Utahns in Medicare Advantage and other health plans and 221,009 in Original Medicare, of 490,235 with Medicare — data.cms.gov. The difference between the two totals is employer group plans, cost plans and timing.

Which Utah counties have a C-SNP, and where is the need?

The plan list is set county by county, and the CDC estimates diabetes and heart disease county by county, so the two can be laid side by side. The CDC's PLACES project puts diagnosed diabetes among Utah adults between 6.9% in Utah County and 15.4% in San Juan County, against 12.0% nationally, and coronary heart disease between 3.7% in Utah County and 10.2% in Piute County, against 6.4%. These are rates among all adults, not among people on Medicare, where both conditions are far more common; they show where the burden is heaviest relative to the rest of the state.

All 29 Utah counties, sorted by September 2026 C-SNP enrollment. Plan counts: CMS CY2026 and CY2027 Landscape files. Enrollment: our tabulation of CMS Monthly Enrollment by Contract/Plan/State/County, September 2026; counts of 10 or fewer are withheld, so the smallest counties are understated and a dash does not mean zero. Diabetes and heart disease: CDC PLACES, county data, 2025 release, 2023 model-based crude prevalence among adults 18 and older — data.cdc.gov. National rates from the same dataset's U.S. rows.

The pattern is the one Utah readers will recognize from our 2027 county-by-county guide: choice follows population. The four Wasatch Front counties, Davis, Salt Lake, Utah and Weber, have all 5 plans and some of the lowest diabetes and heart disease rates in the state. 15 counties, including Washington, Cache, Iron and Uintah, have exactly one. And the three counties with no C-SNP at all, Daggett, Piute and Wayne, are all among the 5 Utah counties where adult diabetes runs above the national rate; Piute County has the state's highest coronary heart disease estimate and no plan. Rich County is the one place the map improved for 2027, going from no C-SNP to three. 12 Utah counties have a coronary heart disease rate above the national figure, and 11 of them have at most one C-SNP to choose from.

In Washington County, which has the largest Medicare population outside the Wasatch Front, 925 people were in the one available C-SNP in September, and the county's diabetes rate of 10.7% and heart disease rate of 6.9% are both above the state's urban counties. For 2027 the list in St. George is unchanged at one plan. In Salt Lake County, 5,968 people were in a C-SNP, and the list goes from three plans to five.

How do you qualify, and how does the plan check?

Medicare.gov sets three requirements for any SNP: you have Part A and Part B, you live in the plan's service area, and you meet the eligibility rule for its type, which for a C-SNP means you have a condition the plan serves. The condition is not taken on your word. CMS's Managed Care Manual says a C-SNP must contact your existing provider before enrollment to verify that you have the qualifying condition. Plans may use a CMS-approved pre-enrollment qualification assessment, a short set of clinical questions with a signature line for a physician or other qualified provider to confirm your eligibility.

If the plan cannot get that confirmation before you enroll, it may enroll you anyway, but it must obtain confirmation from your doctor or a qualified plan provider no later than the end of your first month of enrollment. If it cannot, the manual requires the plan to tell you that you will be disenrolled at the end of the second month, and to send that notice within the first seven calendar days of the second month. Two practical consequences:

1. Have the diagnosis in writing before you apply. A recent visit note, a problem list from your patient portal, or a prescription history that shows the condition is being treated makes the plan's verification call a formality. If your diabetes is managed by diet alone and has not been coded as a diagnosis at a visit in years, ask your doctor to confirm it first.
2. Know what happens if verification fails. Disenrollment at the end of month two puts you back in Original Medicare without a drug plan unless you act. Medicare.gov lists a Special Enrollment Period for people who are in a SNP and no longer have a qualifying condition, running from the month you lose status until you join another plan or three months after the involuntary disenrollment takes effect, whichever is earlier.

When can you join a C-SNP?

Three windows, and the first is the one most people do not know about.

• Any time, if you have the condition. Medicare.gov lists a Special Enrollment Period for someone who has a severe or disabling condition when a Chronic Care SNP that serves that condition is available: you can join at any time of year. But the same entry says that once you join, your chance to make changes using this SEP ends. It is a one-way door, not a standing right to switch among C-SNPs.
• Open Enrollment, October 15 to December 7. Anyone with Medicare can join, switch or leave a Medicare Advantage plan for coverage starting January 1. The 2027 plans are on Medicare Plan Finder by October 1, 2026.
• The Medicare Advantage Open Enrollment Period, January 1 to March 31. If you are already in a Medicare Advantage plan on January 1, you can make one change: to another Medicare Advantage plan, or back to Original Medicare with a drug plan.

If you are considering a C-SNP from Original Medicare with a Medigap policy, the question is not only whether to join but whether you could come back. Medigap insurers in Utah can underwrite most applicants over 65 who apply outside their first six months of Part B, and Utah's birthday rule helps only people who already have a Medigap policy and want to change to one of equal or lesser value with the same insurer. For someone with heart failure or diabetes, a Medigap application after a year in a C-SNP may be declined or rated. The trial right that lets you return to Medigap without underwriting applies only in the first 12 months after you first join Medicare Advantage, as we explain in Medicare Advantage vs. Medigap in Utah.

How do you compare a C-SNP with an ordinary Medicare Advantage plan?

1. Start with the doctors. A C-SNP is an HMO or PPO with its own network. Check that your primary care doctor, your cardiologist or endocrinologist, your hospital and your dialysis or cardiac rehab facility are in it. Two of the five Utah plans for 2027 are new, so provider directories will be new too.
2. Then the drugs. Every SNP includes Part D, but each has its own list and tiers. Run every prescription, including insulin, GLP-1 and SGLT2 drugs, anticoagulants and statins, through Medicare Plan Finder for a total yearly cost, and check for prior authorization or step therapy on any of them.
3. Then the ceiling. In-network out-of-pocket limits on Utah's C-SNPs run from $5,500 to $9,850 for 2027. For a person with heart failure, a year with one hospital stay can reach the limit; the difference between the lowest and highest on the list is $4,350.
4. Then the care model. Ask what the care coordination actually is: a nurse who calls, a care manager assigned to you, a disease-management program, a home visit. It is the thing the plan was approved to provide; find out what it looks like in your county.
5. Then the extras, last. Supplemental benefits and Part B premium reductions are real but change yearly; price them, but do not choose by them.
6. Check the Star Rating. CMS rates each contract from 1 to 5 stars. In the 2026 file the UnitedHealthcare contract behind the 25-county plan carried an overall 4.0 and the Humana contract behind the new plan a 4.5, while Devoted's Utah contract was marked too new to be measured. The 2027 ratings are due on or around October 8, 2026; our Star Ratings guide explains what they measure.
7. Read the prior authorization rules. C-SNPs follow the same Medicare Advantage rules we describe in our prior authorization guide, including the 90-day protection for ongoing treatment when you switch plans.

No-cost, unbiased counseling is available from Utah's State Health Insurance Assistance Program at (877) 424-4640, and from 1-800-MEDICARE at any hour.

A St. George example: one plan, two patients

Take two illustrative retirees in St. George, both 71, both in an ordinary Medicare Advantage PPO this year. Washington County has one C-SNP for 2027, the 25-county HMO-POS, with a $0 plan premium, a $5,500 in-network limit and a $685 drug deductible.

The first has type 2 diabetes managed with metformin and a once-weekly GLP-1 injection, sees a primary care doctor at a clinic that is in the C-SNP's network, and has never been hospitalized. For her, the plan's diabetes care coordination and any supply allowance are worth a look, and the deciding numbers are the GLP-1's tier and whether it needs prior authorization, both of which Plan Finder shows. The verification step is simple: her diabetes is on every visit note.

The second has heart failure after a heart attack, sees a cardiologist in Salt Lake City every three months, and had a four-day hospital stay last winter. He qualifies on heart failure alone. But an HMO-POS asks first whether his cardiologist is in network and what out-of-network care costs under the point-of-service feature; a hospital year puts him near the $5,500 limit, $300 more than this year's; and a year without a Medigap policy makes going back to one harder. Same plan, same county, and two different answers, neither of them found in the premium column.

Why this belongs in a retirement income plan

Because a chronic diagnosis is where the two halves of retirement planning meet. The medical half is bounded: in 2027 a Medicare Advantage member can plan on the Part B premium, the plan's in-network limit of up to $9,850, and at most $2,400 for covered drugs. Diabetes and heart failure are also the conditions that most often lead, years later, to the half that is not bounded: help at home, assisted living or a nursing facility, which neither Medicare Advantage nor Medigap pays for beyond short, skilled stays. A plan that holds up keeps the medical ceiling in cash, reviews the plan each fall when the notices arrive, and funds the long-term care question separately while health still allows it. Start with what Medicare does and does not pay for in long-term care.

Frequently asked questions

Sources

• CMS — CY2027 Landscape and CY2026 Landscape files, release 202609 (every Medicare Advantage plan by county with SNP type, C-SNP condition type, premium, in-network out-of-pocket limit and Part D deductible; Utah rows and national C-SNP counts tabulated by us): cms.gov — landscape files
• CMS — Medicare Open Enrollment in Utah, 2027, fact sheet dated September 28, 2026 (51 Medicare Advantage plans, of which 18 Special Needs Plans; Plan Finder by October 1; Star Ratings on or around October 8): cms.gov — 2027 state fact sheets (PDF)
• CMS — Monthly Enrollment by Contract/Plan/State/County, September 2026 (enrollment by plan and county, all states; counts of 10 or fewer suppressed; Utah and national C-SNP, D-SNP and Medicare Advantage totals as tabulated): cms.gov — monthly enrollment by plan and county
• CMS — Medicare Monthly Enrollment, June 2026 (Utah: 490,235 with Medicare, 269,226 in Medicare Advantage and other health plans, 221,009 in Original Medicare): data.cms.gov — monthly enrollment
• CMS — Chronic Condition Special Needs Plans (the 15 SNP-specific chronic conditions, the limits on each category, the five CMS-approved condition groupings, and the rule that enrollees in a group plan need only one qualifying condition): cms.gov — C-SNPs
• CMS — Medicare Managed Care Manual, Chapter 16-B: Special Needs Plans, Rev. 131, November 22, 2024 (pre-enrollment verification of the qualifying condition; confirmation by the end of the first month; disenrollment at the end of the second month with notice in its first seven days; Part D requirement; Model of Care): cms.gov — Chapter 16-B (PDF)
• CMS — Special Needs Plans overview (statutory definition; all SNPs must provide Part D): cms.gov — SNPs
• CMS — Medicare Advantage rates and statistics, CY2027 MOOP and cost-sharing limit calculations (in-network limits of $4,450, $7,150 and $9,850; $9,250 mandatory limit for 2026): cms.gov — MA rates and statistics
• Medicare.gov — Special Needs Plans (SNP) (who can join; the three types; the 15 condition categories; Part D required; care coordination; staying enrolled only while you meet the condition; limits on charges for chemotherapy, dialysis and skilled nursing care; prior approval rules): medicare.gov — SNPs
• Medicare.gov — Special Enrollment Periods (join a Chronic Care SNP anytime if you have a qualifying condition, after which that SEP ends; SEP after losing SNP eligibility; Medicaid or Extra Help changes): medicare.gov — Special Enrollment Periods
• Medicare.gov — Joining a plan (Open Enrollment October 15 to December 7; Medicare Advantage Open Enrollment Period January 1 to March 31): medicare.gov — joining a plan
• Medicare.gov — Medicare costs (2026 Part B premium $202.90): medicare.gov — costs
• Medicare.gov — How much does Medicare drug coverage cost? ($700 deductible limit and $2,400 out-of-pocket cap for 2027): medicare.gov — drug coverage costs; Insulin (no more than $35 for a one-month supply of each covered insulin product, no deductible): medicare.gov — insulin
• CDC — PLACES: Local Data for Better Health, County Data, 2025 release (diagnosed diabetes and coronary heart disease among adults, 2023 crude prevalence, all 29 Utah counties and U.S.): data.cdc.gov — PLACES county data
• Utah Insurance Department — Medicare consumer page (Utah SHIP (877) 424-4640): insurance.utah.gov

About this article. Written by the Utah Retirement Income Data Desk and reviewed by Brian Penner, Retirement income & long-term care planner. Educational only — not medical, financial, or legal advice, and not a recommendation of any specific plan or insurer. Plan names, condition types, premiums, out-of-pocket limits, deductibles and county listings are as shown in the CMS CY2026 and CY2027 Landscape files (release 202609); eligibility and enrollment rules are quoted from Medicare.gov and the CMS Medicare Managed Care Manual as of October 1, 2026. The enrollment counts, shares and the county table are our own tabulation of the CMS Monthly Enrollment by Contract/Plan/State/County file for September 2026, CMS Medicare Monthly Enrollment for June 2026 and CDC PLACES county estimates, which are model-based estimates for all adults, not counts of Medicare beneficiaries. CMS states that landscape data are subject to change as contracts are finalized, and it suppresses small enrollment counts. Whether a particular diagnosis qualifies is decided by the plan under CMS rules, not by this article. The example retirees are illustrative. Networks, drug lists, copayments and supplemental benefits vary by plan; confirm the details of any plan on Medicare.gov, with the plan, or at 1-800-MEDICARE before you act. Utah Retirement Income is a licensed independent insurance agency (NPN 16493717) and is not a government agency; we are not connected with or endorsed by Medicare, the Centers for Medicare & Medicaid Services, the State of Utah, the Social Security Administration, or any government program, and nothing here should be read as an endorsement by them. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area; please contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Assistance Program — in Utah, the Utah SHIP at (877) 424-4640 — to get information on all of your options. A $0-premium plan is not free; you still pay Part B premiums and cost-sharing. If you call or text us, you consent to be contacted at the number you provide about your options; message and data rates may apply, and you can opt out at any time by replying STOP.