Medicare Special Needs Plans in Idaho for 2027

Most Medicare Advantage plans take anyone with Medicare Parts A and B who lives in the service area. Special Needs Plans do not. They exist for people whose needs are different enough that Medicare lets a plan be designed around them. If you do not qualify, you cannot join, and if you qualify but your doctors are out of network, the extra help does little. This page reads the 2027 CMS files for all 10 Special Needs Plans sold in Idaho: who each kind is for, where it is sold and what to ask first.

The Short Version: Key Takeaways

• Idaho has 10 Special Needs Plans for 2027: 4 dual eligible (D-SNP), 4 chronic condition (C-SNP) and 2 institutional (I-SNP) (CMS CY2027 Landscape).
• All 10 list a $0 Part C premium and include Part D drug coverage. The in-network out-of-pocket maximum runs from $7,150 to $9,850.
• D-SNPs reach the most people: about 73% of the 26,780 or more Idahoans in these plans in October 2026.
• Your county decides your options. 42 of 44 counties have a chronic condition plan, and only 11 have an institutional one.

What a Special Needs Plan Is

A Special Needs Plan is a Medicare Advantage plan that, by federal rule, "exclusively enrolls special needs individuals" and provides Part D drug benefits to every enrollee (42 CFR 422.2). The same rule defines a special needs individual as someone who is institutionalized or institutionalized-equivalent, is entitled to Medicaid, or has a severe or disabling chronic condition and would benefit from a specialized plan.

Source: 42 CFR 422.2, definitions (Electronic Code of Federal Regulations, October 2026); plan counts from the CMS CY2027 Landscape file, Idaho, accessed November 12, 2026.

A Special Needs Plan is still Medicare Advantage: it covers what Parts A and B cover, uses a network and has a yearly out-of-pocket maximum. The plan also screens you. For a chronic condition plan, the plan must confirm the condition with your current doctor or through a verified assessment before or shortly after enrollment (42 CFR 422.52). We help you gather what is needed, but we do not decide eligibility.

Dual Eligible Plans (D-SNP): For People With Medicare and Medicaid

A dual eligible plan serves people who have both Medicare and Medicaid. Under the federal rule, a D-SNP coordinates the delivery of Medicare and Medicaid services and may cover some Medicaid services itself, including long-term services and behavioral health (42 CFR 422.2). Which Medicaid benefits it covers is set in its contract with the state Medicaid agency (42 CFR 422.107). If you may qualify for Medicaid, we help you start that application.

CMS labels each D-SNP with an integration status, which shows how closely the plan ties Medicare and Medicaid together.

Source: CMS CY2027 Landscape file (202610), Idaho, columns "D-SNP Integration Status" and "Medicare Zero-Dollar Cost Sharing D-SNP", accessed November 12, 2026.

Three of the four are fully integrated (FIDE): under 42 CFR 422.2, a single entity holds both the Medicare Advantage contract and a Medicaid managed care contract with the state. The fourth, UHC Dual Complete ID-QV1, is listed as coordination only, so it is not fully or highly integrated, and its state contract must arrange notice of hospital and skilled nursing facility admissions for high-risk members (42 CFR 422.107(d)). CMS marks three of the four as zero-dollar cost sharing plans. What that means for your bills depends on your Medicaid category, so we read the Evidence of Coverage with you first.

The three UHC Dual Complete plans show "Plan Too New To Be Measured" instead of a star rating, which means CMS lacks data, not that the plan scores low. Molina Medicare Complete Care carries a 3.0 of 5.

Chronic Condition Plans (C-SNP): For Specific Conditions

A chronic condition plan restricts enrollment to people who have one or more severe or disabling chronic conditions the plan is built around (42 CFR 422.2). The federal list is long. It includes cardiovascular disorders, chronic heart failure, diabetes mellitus, dementia, chronic kidney disease, cancer and several others. Each plan serves only the condition groups it names, and the plan must verify that you have one before you can stay enrolled.

All four Idaho C-SNPs for 2027 serve the same three linked groups: cardiovascular disorders, chronic heart failure and diabetes mellitus. That makes them useful for the many Idahoans who live with diabetes and heart disease together, and not useful for someone whose condition falls outside those groups.

The four are UHC Complete Care Support ID-1A (PPO, 42 counties), UHC Complete Care ID-13 (HMO-POS, 17 counties), UHC Complete Care ID-12 (HMO-POS, 7 counties) and HumanaChoice Diabetes and Heart (PPO, 7 counties); the full comparison is in the table below. The in-network out-of-pocket maximum caps what you pay for covered Part A and B services in the network (CMS Landscape file): $7,150 on the two HMO-POS plans, $9,850 on the two PPOs. Neither number says whether your own cardiologist or endocrinologist is in the network. That question comes first.

Institutional Plans (I-SNP): For People in Facilities

An institutional plan enrolls people who meet the federal definition of institutionalized, meaning they continuously live or are expected to live 90 days or longer in a long-term care setting such as a skilled nursing facility or nursing facility, and, in some plans, people at home who need an institutional level of care (42 CFR 422.2). The rule recognizes three subtypes: facility-based (FI-SNP), institutional-equivalent (IE-SNP) and hybrid (HI-SNP).

Idaho has two for 2027. American Health Advantage of Idaho is a hybrid HMO sold in 10 counties. UHC Nursing Home Plan ID-F1 is a facility-based PPO sold in 1 county (Kootenai) and shows no October 2026 enrollment. Facility-based plans must own or contract with an institution in every county they serve (42 CFR 422.2), so the question is whether the plan serves the facility where the person lives.

The 10 Special Needs Plans Sold in Idaho for 2027

Every Special Needs Plan in the CMS CY2027 Landscape file for Idaho is below. All ten have a $0 Part C premium and Part D drug coverage. We do not offer every plan available in your area, and no plan is better for appearing first.

Source: CMS CY2027 Landscape file (202610), Idaho, accessed November 12, 2026. Molina Medicare Complete Care is two plan segments that together cover 43 counties.

UnitedHealthcare sells 7 of the 10, including all three D-SNPs that are sold in all 44 counties, so for dual eligible people the choice is often UnitedHealthcare or Molina. The plans with the lowest out-of-pocket maximums, $7,150 and $7,250, are sold in only 7 to 17 counties, while every plan sold in 42 to 44 counties shows $9,850.

How Many Idahoans Use Special Needs Plans

CMS's October 2026 enrollment file shows at least 26,780 Idahoans in these plans, about 6.4% of the 416,679 Idahoans on Medicare (CMS enrollment file, CMS fact sheet). CMS suppresses county cells of 10 or fewer, so these counts are floors.

Source: CMS Monthly Enrollment by Contract, Plan, State and County, October 2026, Idaho counties, accessed November 12, 2026. Our sums.

Dual eligible plans hold about 73% of enrollment, and one plan, Molina Medicare Complete Care, holds more than a third of the total. Size says nothing about fit, and a big plan can change its network next year.

What Your County Offers

Special Needs Plans are sold by county. Across the 44 counties in the Landscape file, the options stack up like this.

Frequently Asked Questions

Keep Reading

• Medicare plans in Idaho: 2027 statewide guide
• Medicare plans in Ada County, Idaho for 2027
• Medicare plans in Canyon County, Idaho for 2027
• Medicare plans in Boise County, Idaho for 2027
• Medicare Advantage vs. Medicare Supplement in Idaho
• When can I change my Medicare plan?
• Learning Center: Medicaid, Medicare Savings Programs and Extra Help
• Medicare Advantage plans