EP12 83% of 2026 Medicare Advantage Growth Came from SNPs

🎙️ Episode Description 

Medicare Advantage reached 35 million enrollees in February 2026, but nearly all meaningful growth is coming from Special Needs Plans.

In this episode of The Insurance Producers Guild, we break down new Kaiser Family Foundation and ATI Advisory data showing SNPs accounted for 83% of Medicare Advantage enrollment growth over the past year. While general MA enrollment remained mostly flat, Chronic Condition SNPs (C-SNPs) continued to expand rapidly.

We explain why this matters for agents, how CMS-approved chronic conditions create a large qualifying population, and why many producers may already have eligible clients inside their existing book of business. The episode also covers year-round SEP opportunities, compliant condition-based conversations, and practical ways agents can identify C-SNP opportunities now.

🔑 Key Topics Covered

• SNPs accounted for 83% of MA enrollment growth in 2026 
• Rapid C-SNP growth compared to general MA and D-SNPs 
• CMS chronic condition eligibility and year-round SEP opportunities 
• How agents can identify C-SNP prospects within their current book 

🎯 What This Means for Agents

• General MA growth may be slowing, but SNP opportunities are expanding 
• Many agents likely already have C-SNP eligible clients 
• Condition-based reviews can create compliant year-round enrollment opportunities 
• Understanding C-SNP availability and eligibility may become increasingly important in 2026 

📌 GO-DO (Next 24–48 Hours)

Review your Medicare book for clients with chronic conditions like diabetes, CHF, COPD, cancer, ESRD, dementia, stroke, or HIV.

For each client:

• Check for available C-SNPs in their county 
• Confirm your carrier appointments 
• Schedule a 15-minute review call 

📞 Client Opener

“Carriers are offering plans designed specifically for people with [condition], often with tailored drug coverage and added benefits. Would you be open to a quick 15-minute review to see if you qualify?”

C-SNPs create a year-round enrollment opportunity for qualifying clients.

Infographic: https://11198.fs1.hubspotusercontent-na1.net/hubfs/11198/The%20Insurance%20Producers%20Guild/IPG_EP12%20Infographic.png
Slides: https://11198.fs1.hubspotusercontent-na1.net/hubfs/11198/The%20Insurance%20Producers%20Guild/IPG_EP12%20Slides.pdf

🔗 Sources

KFF Medicare Advantage Enrollment Brief:
 https://www.kff.org/medicare/medicare-advantage-enrollment-grew-by-about-1-million-people-mainly-due-to-special-needs-plans/

ATI Advisory SNP Growth Analysis:
 https://atiadvisory.com/resources/special-needs-plans-drive-2026-medicare-advantage-growth/

CMS C-SNP Guidance:
 https://www.cms.gov/medicare/enrollment-renewal/special-needs-plans/chronic-conditions/

The Insurance Producers Guild Podcast delivers intelligence for insurance agents looking to stay ahead of industry trends.

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Transcript

SPEAKER_00 0:00

You know that feeling. You are sitting at your desk, looking at your pipeline, and just feeling the absolute squeeze.

SPEAKER_01 0:06

Oh yeah. I hear it from agents every single week.

SPEAKER_00 0:08

Right. I mean the numbers are officially out. Total Medicare Advantage enrollment just hit 35 million people.

SPEAKER_01 0:14

Which uh on the surface sounds like a massive victory for the industry.

SPEAKER_00 0:18

It does. But the growth rate has slowed down to a mere 3% year over year. We are talking about adding only 1.1 million net new enrollees.

SPEAKER_01 0:28

Wow. That is a low.

SPEAKER_00 0:31

Yeah, it is the slowest pace of growth in nearly two decades. I talk to agents every day, and I could hear the genuine anxiety in their voices.

SPEAKER_01 0:39

Aaron Powell Well, sure. They feel like the well is simply drying up. They're working twice as hard for, you know, half the results.

SPEAKER_00 0:45

Exactly. But I have been through this before. I saw this exact same panic back when the industry shifted in the early 2000s.

SPEAKER_01 0:51

So what is actually happening under the surface then?

SPEAKER_00 0:54

The growth did not disappear, it concentrated. When a market saturates, the real growth always moves into specialized, underserved segments.

SPEAKER_01 1:02

Ah, right. It is a natural evolution of any mature market.

SPEAKER_00 1:06

Precisely. So we are going to name that fear right now and completely dissolve it. You are not losing your pipeline. You are just uh looking for your prospects in the entirely wrong place.

SPEAKER_01 1:17

I love that. We are going to show you exactly where that 1.1 million net growth actually went.

SPEAKER_00 1:22

And more importantly, how to actually capitalize on it.

SPEAKER_01 1:25

Right. We are going to break down how you can monetize it right now. We need to move away from the industry panic, look at the hard data, and give you the context to pivot your sales strategy today.

SPEAKER_00 1:35

So to understand how to pivot, you first need to look at the raw numbers. We have to see where the buyers are actually migrating.

SPEAKER_01 1:41

Okay. Let us get into it. What are we looking at?

SPEAKER_00 1:43

Well, we have the February 2026 analysis from KFF, and the breakdown is absolutely stunning.

SPEAKER_01 1:50

I read this one. The numbers are wild.

SPEAKER_00 1:52

They really are. Out of that 1.1 million netcold we just talked about, an astounding 83% came from special needs plans.

SPEAKER_01 1:59

Wait, 83%? Just from SMPs.

SPEAKER_00 2:02

Yes, 83%. Let that sink in for a moment. More than 8 million people are now enrolled in the SMP.

SPEAKER_01 2:08

That is a massive chunk of the market.

SPEAKER_00 2:10

It is. These special needs plans now make up 23% of the entire Medicare Advantage market. That is up from just 13% back in 2018.

SPEAKER_01 2:20

So for anyone listening who is maybe new to this, a special needs plan or SNP is a customized MA plan tailored to specific groups of people.

SPEAKER_00 2:28

Right, folks with specific diseases or healthcare characteristics.

SPEAKER_01 2:32

Let me translate those percentages directly to what happens on the sales floor every single day.

SPEAKER_00 2:36

Please do, because that is what matters.

SPEAKER_01 2:38

Agents who are leading their appointments with generic general MA presentations are fighting brutally for just 17% of the market's total growth.

SPEAKER_00 2:47

Oh man, that is a tough spot to be in.

SPEAKER_01 2:50

It is exhausting. They are spending their hard-earned marketing dollars, making hundreds of outbound calls, and competing with every other agent in their zip code for a tiny sliver of the pie.

SPEAKER_00 2:59

While missing the actual opportunity.

SPEAKER_01 3:01

Exactly. Meanwhile, the agents who actually know how to identify and qualify SP candidates are quietly scooping up the other 83% with almost no resistance.

SPEAKER_00 3:11

I look at these numbers and it almost feels like a magic trick. It is like complaining there are no houses left to sell in the suburbs while completely ignoring an entire high-rise being built downtown.

SPEAKER_01 3:23

That is a great way to put it. The buyers did not vanish, they just moved to a different zip code.

SPEAKER_00 3:27

Right. And the KFF data shows smaller insurers are the ones figuring this out. Insurers with fewer than 1 million enrollees saw a phenomenal growth of 734,000 people.

SPEAKER_01 3:40

Really? How did smaller regional carriers beat the massive national giants to the punch on that?

SPEAKER_00 3:45

They pivoted faster. The smaller insurers found the current and they wrote it. They realized that the standard buyer turning 65 is no longer the sole driver of growth.

SPEAKER_01 3:55

Because the needs of the population have shifted entirely towards specialized care.

SPEAKER_00 3:59

Exactly. If your entire strategy is based on general MA, you are ignoring the vast majority of the new business entering the system.

SPEAKER_01 4:05

You are choosing to play the hardest game possible, but we cannot just stop at SPs as a broad category.

SPEAKER_00 4:10

No, absolutely not. Knowing that special needs plans are growing is only a piece of the puzzle. There are different types of SPs.

SPEAKER_01 4:17

Right. We have dual eligible SNPs for folks on both Medicare and Medicaid.

SPEAKER_00 4:22

And we have chronic condition SNPs. We really need to figure out which specific engine is driving this massive shift.

SPEAKER_01 4:29

For that level of detail, we need to look at the March 2026 ATI advisory analysis.

SPEAKER_00 4:34

Oh, this is the one that really blew my mind.

SPEAKER_01 4:36

Yeah, this is where the numbers get truly fascinating and uh where the actionable strategy emerges.

SPEAKER_00 4:42

Walk us through it.

SPEAKER_01 4:43

So as we mentioned, general MA enrollment is essentially flat. Dual eligible SNPs, the DSNPs, grew by roughly 4%.

SPEAKER_00 4:51

Okay, 4% solid, but not crazy.

SPEAKER_01 4:54

Right. However, chronic condition SNPs, the CSNPs, grew by approximately 14%.

SPEAKER_00 5:00

Wait, I want to make sure I'm framing that correctly. CSMPs grew about 14 times faster than general Medicare Advantage plants.

SPEAKER_01 5:06

Yes, 14 times faster. That is a staggering multiple.

SPEAKER_00 5:09

It is undeniable.

SPEAKER_01 5:10

And this builds perfectly on KFF's separate brief from September 2025.

SPEAKER_00 5:15

Oh, right. I remember that one.

SPEAKER_01 5:16

That brief documented a massive 71% year-over-year jump for CSNPs between 2024 and 2025.

SPEAKER_00 5:23

That is just explosive growth.

SPEAKER_01 5:24

It is. CSNPs accounted for a full 75% of all SP growth in that period.

SPEAKER_00 5:30

Across both years, CSMPs are definitively the fastest moving segment in the entire industry.

SPEAKER_01 5:37

Without a doubt.

SPEAKER_00 5:38

You know, when I see a jump like 71%, my alarm bells go off.

SPEAKER_01 5:41

Oh so.

SPEAKER_00 5:42

Well, that is not a random consumer trend. People do not just suddenly wake up and decide to buy a specialized insurance product. I see a structural pattern.

SPEAKER_01 5:52

Ah, I see what you mean. The regulatory side of things.

SPEAKER_00 5:55

Exactly. This is regulatory plumbing actively driving the shift. Let us think about the mechanics of what has happened recently.

SPEAKER_01 6:02

Okay, let us break that down.

SPEAKER_00 6:03

DSNPs are for folks who qualify for both Medicare and state-run Medicaid. But state Medicaid agencies have their own massive budget crunches.

SPEAKER_01 6:11

Oh yeah, they have been tightening the belt everywhere.

SPEAKER_00 6:13

Right. They have actively limited certain DSMP offerings. On top of that, the Centers for Medicare and Medicaid Services, CMS, has tightened the use of general enrollment plans to enroll dual eligibles.

SPEAKER_01 6:24

So the doors are closing on that side, but the carriers are smart.

SPEAKER_00 6:28

Very smart.

SPEAKER_01 6:28

They realized the regulatory doors for dual eligible plans were closing. In response to these strict restrictions, Medicare Advantage organizations rapidly expanded their CSNP offerings.

SPEAKER_00 6:40

They built the products exactly where the regulations allowed for growth.

SPEAKER_01 6:43

They even designed chronic condition plans that primarily enrolled dual eligible beneficiaries. They just used a different regulatory vehicle to reach the same underserved market.

SPEAKER_00 6:53

Here is the play I would run based on that pattern. You have to recognize this is a permanent structural shift, not a one-year blip.

SPEAKER_01 7:01

Right. You cannot just ignore this and hope general MA bounces back.

SPEAKER_00 7:04

Exactly. You have to align your business with the current regulatory reality. The carriers have laid the track. You just need to drive the train on it.

SPEAKER_01 7:12

Let us talk about why this matters for your wallet today. Because this is the monetization angle where agents can truly transform their yearly income.

SPEAKER_00 7:20

Oh, absolutely. This is the best part.

SPEAKER_01 7:21

General MA plans are heavily tied to the annual enrollment period in the fall. You grind for a few months and then you try to survive the rest of the year.

SPEAKER_00 7:29

It is the classic feast or famine cycle.

SPEAKER_01 7:32

Right. But because newly qualifying members for chronic condition SNP trigger a year-round special enrollment period, CSNPs are not just an AEP product.

SPEAKER_00 7:43

Wait, hold on. A year-round special enrollment period sounds great in theory, but are we talking about a steady stream of business or just a random trickle of people who happen to get diagnosed in July?

SPEAKER_01 7:53

No, it is a steady, predictable stream. An agent who is appointed for CSMPs writes business every single month of the year.

SPEAKER_00 8:01

Aaron Powell Because people are diagnosed with qualifying conditions all year long.

SPEAKER_01 8:04

Exactly. Their health status changes all year long. The urgency here is that if you do not have these products in your bag, you are sidelined for nine months of the year.

SPEAKER_00 8:13

Aaron Powell You are essentially telling your clients you cannot help them when they need you the most.

SPEAKER_01 8:17

Exactly. And that is terrible for retention.

SPEAKER_00 8:20

Aaron Powell So the carriers built the pipeline, the regulations paved the way, and the agents who secure these appointments are essentially bulletproofing their income against market slowdowns.

SPEAKER_01 8:29

It is a brilliant pivot.

SPEAKER_00 8:30

It is. But it brings us to the most critical hurdle. We have established that CSNPs are the fastest growing segment, and we know they offer incredible year-round selling opportunities.

SPEAKER_01 8:41

Right. The logical next question is where you actually find these highly lucrative prospects.

SPEAKER_00 8:46

Exactly. Agents hearing this are probably thinking they need to spend $5,000 on specialized marketing leads or buy expensive new medical data lists.

SPEAKER_01 8:56

Oh, I see agents out there desperate for leads, completely ignoring the gold mine they have already built.

SPEAKER_00 9:01

So where are they?

SPEAKER_01 9:02

The truth is much simpler. Your CSMP prospects are already sitting right there in your existing filing cabinet.

SPEAKER_00 9:08

Really? Just right in their current book of business.

SPEAKER_01 9:10

Absolutely.

SPEAKER_00 9:11

Okay, let us break down the CMS guidelines because the scope of this is what truly changes the game.

SPEAKER_01 9:16

Yeah, the numbers here are surprising.

SPEAKER_00 9:18

CMS approves CSMPs around 15 specific chronic conditions. And we are not talking about rare, obscure diseases.

SPEAKER_01 9:26

Right. These are everyday conditions.

SPEAKER_00 9:28

Exactly. We are talking about major, incredibly common health issues. The approved list includes diabetes, chronic heart failure, cardiovascular disorders, dementia, and cancer.

SPEAKER_01 9:39

It covers a lot of ground.

SPEAKER_00 9:41

It also covers things like end-stage renal disease, COPD, HIV, and stroke. Furthermore, CMS approves multi-conditioned groupings.

SPEAKER_01 9:50

What does that mean exactly?

SPEAKER_00 9:51

They will approve a plan specifically for someone who has both diabetes and chronic heart failure, for example.

SPEAKER_01 9:57

Ah, I see. Well, here is the statistic that should change your entire week. Roughly two-thirds of Medicare beneficiaries have multiple chronic conditions.

SPEAKER_00 10:06

Wait, two-thirds. Are you serious?

SPEAKER_01 10:08

Two-thirds. It is a massive portion of the population.

SPEAKER_00 10:10

Aaron Powell I want every agent listening to process that number. Two-thirds of the Medicare population.

SPEAKER_01 10:15

That is most of your clients.

SPEAKER_00 10:17

Exactly. Every single agent listening to this right now has a massive list of CSMP candidates sitting in their book of business today.

SPEAKER_01 10:24

You have hundreds of clients who qualify for these specialized plans, but you simply have not asked them the question.

SPEAKER_00 10:30

You are literally sitting on a mountain of year-round business.

SPEAKER_01 10:33

The only real barrier is knowing how to compliantly ask the question.

SPEAKER_00 10:37

Right. Because CMS has very strict rules regarding marketing and health questions. You cannot just call up a client and demand their medical history.

SPEAKER_01 10:44

No, absolutely not. But CMS absolutely allows agents to ask clients if they have a qualifying condition corresponding to available CSNPs in their market.

SPEAKER_00 10:55

Okay, so how do you actually word that?

SPEAKER_01 10:58

Let me give you the exact script to use. This is what I would say word for word. I am listening. I would say this carrier offers a plan specifically designed for people with diabetes. Would you like to learn more?

SPEAKER_00 11:09

If you do not have CSMP carrier appointments, PSM brokerage's contracting support can set those up.

SPEAKER_01 11:15

Exactly. And once the client says yes to learning more, the verification process takes over.

SPEAKER_00 11:20

Hold on though, because CMS rules are incredibly strict about what we can and cannot ask regarding health conditions during marketing.

SPEAKER_01 11:28

They are, which is why the phrasing is so important.

SPEAKER_00 11:30

Aaron Powell Are you completely sure we can just ask a direct medical question like that without violating compliance?

SPEAKER_01 11:36

Yes, because of how you frame it. You are not practicing medicine. Right. You are not asking them for a list of their prescriptions to diagnose them. You are offering a tailored insurance solution based on a specific plan design.

SPEAKER_00 11:50

Aaron Powell So you just state the plan's purpose and you ask if they want to learn more.

SPEAKER_01 11:55

Aaron Ross Powell Exactly. It is entirely compliant and it puts the client in control of disclosing their condition.

SPEAKER_00 12:00

Aaron Powell That makes perfect sense. But that verification process is exactly what scares agents away.

SPEAKER_01 12:05

I know, I hear that all the time.

SPEAKER_00 12:06

Aaron Powell I have heard verifying chronic conditions takes weeks, requires a ton of back and forth with doctors, and ultimately kills the sale because the client gets frustrated. Is that true?

SPEAKER_01 12:18

It is a complete myth.

SPEAKER_00 12:19

Really? So it is not a nightmare?

SPEAKER_01 12:21

Not at all. The verification process is incredibly straightforward. It typically requires a simple doctor's note or a carrier-issued chronic condition verification form.

SPEAKER_00 12:30

Oh, that is much easier than I thought.

SPEAKER_01 12:32

In many cases, the carrier handles the heavy lifting of contacting the doctor once the client signs the authorization.

SPEAKER_00 12:38

So the agent is not stuck playing telephone with a medical clinic.

SPEAKER_01 12:42

No, you do not need to be a medical expert. You just need to facilitate the necessary paperwork to get them the specialized care they deserve.

SPEAKER_00 12:50

That is a relief.

SPEAKER_01 12:51

The carrier wants the business just as much as you do, so they have streamlined this process drastically over the last few years.

SPEAKER_00 12:58

That completely changes the dynamic.

SPEAKER_01 12:59

Yeah.

SPEAKER_00 13:00

You are moving from a transactional relationship to a deeply consultative one.

SPEAKER_01 13:04

Exactly. You become a true advisor.

SPEAKER_00 13:06

You are doing them a massive service by connecting them with a plan designed specifically for their unique health needs, rather than shoehorning them into a generic, general MA plan.

SPEAKER_01 13:18

Right. A plan that might not cover their specialized insulin or their specific cardiologists.

SPEAKER_00 13:23

So the action plan for this week is crystal clear.

SPEAKER_01 13:26

Yes, it is. You need to review your book of business.

SPEAKER_00 13:28

Look at your existing client list, pick up the phone, and start asking the condition question.

SPEAKER_01 13:33

You have clients who are struggling with their copays for diabetic supplies. You have clients who are overwhelmed by their cardiovascular care costs.

SPEAKER_00 13:42

They need these plans and they are waiting for someone to offer a solution.

SPEAKER_01 13:46

Exactly. They are just waiting for the call.

SPEAKER_00 13:49

I want to leave everyone with a retention warning to really mull over. Think about that two-thirds statistic again.

SPEAKER_01 13:55

It is a big number.

SPEAKER_00 13:56

Two-thirds of the Medicare population has these qualifying chronic conditions. If you are not asking your clients about their specialized health needs, another agent eventually will.

SPEAKER_01 14:06

Oh, absolutely. They will get a mailer or a phone call.

SPEAKER_00 14:09

You simply cannot leave the back door open like that. Securing a client in a specialized CSNP not only provides them with far better tailored care, but it completely insulates your book from competitors pushing generic plans.

SPEAKER_01 14:23

It builds incredible loyalty.

SPEAKER_00 14:25

It does. Remember that feeling of dread looking at a shrinking pipeline we talked about at the start?

SPEAKER_01 14:30

Yeah, that awful sinking feeling.

SPEAKER_00 14:32

You dissolve that fear by understanding where the market actually moved. Growth is out there, and it is waiting in your own filing cabinet.

SPEAKER_01 14:39

That's this episode of the Insurance Producers Guild. Stay tuned for the next episode.