Special Needs Plan Comprehensive Report - snpalliance.orgsnpalliance.org/media/1290/snp_2019_01a.pdf · Cardio DIS CHF and Diabetes H2793 IMPERIAL INSURANCE COMPANY OF TEXAS, INC

NOTES:Data is as of January 2019The data source for this report is the CMS Health Plan Management System. Records with enrollment between 1 and 10 (inclusive) are set to blank in order to comply with privacy law requirements. A record with fictitious contract number "Under-11" has been added for each SNP type, aggregating all records of that type with 1-10 enrollment.Employer-only group plans are omitted from this report.

SNP TypeNumber of Contracts

Number of Plans

Sub Total Enrollment SNP Type Enrollment

Number of Plans

Chronic or Disabling Condition 56 129 351,002 Chronic or Disabling Condition 38 12Dual-Eligible 208 480 2,442,708 Dual-Eligible 81 37

Institutional 57 125 83,597 Institutional 20 37Totals 321 734 2,877,307 Under - 11 Totals 139 86

Contract Number Contract Name

Organization Type Plan ID

Segment ID Plan Name Plan Type Plan Geographic Name State(s)

Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH0028 CHA HMO, INC. Local CCP 039 0 Humana Gold Plus -

Diabetes and Heart (HMO SNP)

HMO Corpus Christi Metro Area TX 373 Chronic or Disabling Condition

Cardio DIS CHF and Diabetes

H0028 CHA HMO, INC. Local CCP 040 0 Humana Gold Plus - Diabetes and Heart (HMO SNP)

HMO San Antonio Metro Area TX 836 Chronic or Disabling Condition


H0294 CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY

Local CCP 002 0 UnitedHealthcare MedicareComplete Assist (PPO SNP)

Local PPO Select counties in Wisconsin WI 2,547 Chronic or Disabling Condition



Local CCP 010 0 UnitedHealthcare MedicareComplete Assist (PPO SNP)

Local PPO Select counties in Wisconsin WI 329 Chronic or Disabling Condition


H0351 HEALTH NET OF ARIZONA, INC. Local CCP 038 0 Allwell CHF/Diabetes Medicare (HMO SNP)

HMO Maricopa and Pinal Counties AZ 1,749 Chronic or Disabling Condition

CHF Diabetes

H0354 CIGNA HEALTHCARE OF ARIZONA, INC.

Local CCP 027 0 Cigna-HealthSpring Achieve Plus (HMO SNP)

HMO Maricopa Co. and Select Zip Codes in Pinal Co.

AZ 5,466 Chronic or Disabling Condition

Diabetes Mellitus

H0544 BLUE CROSS OF CALIFORNIA Local CCP 004 0 Anthem Diabetes (HMO SNP)

HMO Los Angeles and Orange Counties CA 10,007 Chronic or Disabling Condition

Diabetes Mellitus


HMO San Bernardino County CA 1,776 Chronic or Disabling Condition

Diabetes Mellitus

H0544 BLUE CROSS OF CALIFORNIA Local CCP 013 0 Anthem Heart (HMO SNP)


Cardio Disorders CHF

H0544 BLUE CROSS OF CALIFORNIA Local CCP 014 0 Anthem Breathe (HMO SNP)


Chronic Lung Failure

H0544 BLUE CROSS OF CALIFORNIA Local CCP 015 0 Anthem ESRD (HMO SNP)


End Stage Renal

Under - 11Aggregate Information

Special Needs Plan Comprehensive Report

SNP_2019_01A Page 1




Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH0544 BLUE CROSS OF CALIFORNIA Local CCP 019 0 Anthem Breathe (HMO

SNP)HMO San Bernardino County CA 408 Chronic or

Disabling Condition


H0544 BLUE CROSS OF CALIFORNIA Local CCP 020 0 Anthem ESRD (HMO SNP)

HMO San Bernardino County CA 248 Chronic or Disabling Condition

End Stage Renal


HMO Santa Clara, San Benito County CA 135 Chronic or Disabling Condition




Diabetes Mellitus


HMO Stanislaus County CA 154 Chronic or Disabling Condition




Diabetes Mellitus








HMO San Bernardino County CA 314 Chronic or Disabling Condition


H0562 HEALTH NET OF CALIFORNIA,INC. Local CCP 092 0 Health Net Jade (HMO SNP)

HMO Kern, L. A. and Orange Counties CA 6,810 Chronic or Disabling Condition


H0562 HEALTH NET OF CALIFORNIA,INC. Local CCP 114 0 Health Net Jade (HMO SNP)

HMO San Diego CA 333 Chronic or Disabling Condition


H0838 UNIVERSAL CARE, INC. Local CCP 020 0 Brand New Day Harmony Choice Plan (HMO SNP)

HMO FRE IMP KER KIN LA ORA RIV SBD SCL SD SM TUL

CA 2,148 Chronic or Disabling Condition

Chronic Mental Health

H0838 UNIVERSAL CARE, INC. Local CCP 028 0 Brand New Day Bridges Care Plan (HMO SNP)

HMO FRE IMP KER KIN LA ORA RIV SBD SD SM SCL TUL

CA 173 Chronic or Disabling Condition

Dementia

H0838 UNIVERSAL CARE, INC. Local CCP 029 0 Brand New Day Bridges Choice Plan (HMO SNP)



Dementia

H0838 UNIVERSAL CARE, INC. Local CCP 032 0 Brand New Day Harmony Care Plan (HMO SNP)

HMO FRE IMP KIN KER LA ORA RIV SBD SCL SD SM TUL


Chronic Mental Health

H0838 UNIVERSAL CARE, INC. Local CCP 039 2 Brand New Day Embrace Care Plan (HMO SNP)




H0838 UNIVERSAL CARE, INC. Local CCP 039 1 Brand New Day Embrace Care Plan (HMO SNP)




H0838 UNIVERSAL CARE, INC. Local CCP 040 1 Brand New Day Embrace Choice Plan (HMO SNP)




SNP_2019_01A Page 2




Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH0838 UNIVERSAL CARE, INC. Local CCP 040 2 Brand New Day

Embrace Choice Plan (HMO SNP)




H1032 WELLCARE OF FLORIDA, INC. Local CCP 184 0 WellCare Guardian (HMO SNP)

HMO Select Counties in FL FL 53 Chronic or Disabling Condition


H1032 WELLCARE OF FLORIDA, INC. Local CCP 186 0 WellCare Guardian (HMO SNP)

HMO Select Counties in FL FL Chronic or Disabling Condition


H1032 WELLCARE OF FLORIDA, INC. Local CCP 203 0 WellCare Champion (HMO SNP)

HMO Select Counties in FL FL 39 Chronic or Disabling Condition


H1036 HUMANA MEDICAL PLAN, INC. Local CCP 121 0 Humana Gold Plus - Diabetes (HMO SNP)

HMO Broward County FL 1,002 Chronic or Disabling Condition

Diabetes Mellitus


HMO Palm Beach County FL 651 Chronic or Disabling Condition

Diabetes Mellitus


HMO Flagler and Volusia counties FL 490 Chronic or Disabling Condition

Diabetes Mellitus


HMO Tampa Metro Area FL 635 Chronic or Disabling Condition

Diabetes Mellitus


HMO Jacksonville Area FL 632 Chronic or Disabling Condition

Diabetes Mellitus

H1036 HUMANA MEDICAL PLAN, INC. Local CCP 234 0 Humana Community HMO Diabetes and Heart (HMO SNP)

HMO Jefferson County KY 614 Chronic or Disabling Condition


H1045 PREFERRED CARE PARTNERS, INC. Local CCP 018 0 Preferred Special Care Miami-Dade (HMO SNP)

HMO Miami-Dade County FL 2,598 Chronic or Disabling Condition


H1468 HUMANA BENEFIT PLAN OF ILLINOIS, INC.

Local CCP 017 0 Humana Community HMO Diabetes and Heart (HMO SNP)

HMO Cook, DuPage and Will counties IL 5,925 Chronic or Disabling Condition


H1951 HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.

Local CCP 044 0 Humana Gold Plus - Diabetes and Heart (HMO SNP)

HMO Jefferson and Orleans Parishes LA 2,106 Chronic or Disabling Condition


H1994 SELECTHEALTH, INC. Local CCP 010 0 SelectHealth Advantage - Diabetes and Heart Care (HMO SNP)

HMO Clark County Nevada NV 174 Chronic or Disabling Condition


H1994 SELECTHEALTH, INC. Local CCP 011 0 SelectHealth Advantage - Lung Care (HMO SNP)

HMO Clark County Nevada NV 50 Chronic or Disabling Condition


H2108 BRAVO HEALTH MID-ATLANTIC, INC. Local CCP 029 0 Cigna-HealthSpring Achieve (HMO SNP)

HMO Maryland, Washington DC and Delaware Counties

DC; DE; MD 667 Chronic or Disabling Condition

Diabetes Mellitus

H2108 BRAVO HEALTH MID-ATLANTIC, INC. Local CCP 030 0 Cigna-HealthSpring Achieve (HMO SNP)

HMO Select Maryland Counties MD 771 Chronic or Disabling Condition

Diabetes Mellitus

SNP_2019_01A Page 3




Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH2334 EON HEALTH, INC. (SC) Local CCP 001 0 EON GOLD (PPO

SNP)Local PPO Select South Carolina Counties SC Chronic or

Disabling Condition


H2593 AMERIGROUP TEXAS, INC. Local CCP 005 0 Amerivantage CareMore COPD (HMO SNP)

HMO Pima County AZ 832 Chronic or Disabling Condition


H2593 AMERIGROUP TEXAS, INC. Local CCP 006 0 Amerivantage CareMore Diabetes (HMO SNP)

HMO Pima County AZ 3,152 Chronic or Disabling Condition

Diabetes Mellitus

H2593 AMERIGROUP TEXAS, INC. Local CCP 013 0 Amerivantage CareMore Heart Care (HMO SNP)

HMO Pima County AZ 1,006 Chronic or Disabling Condition


H2593 AMERIGROUP TEXAS, INC. Local CCP 031 0 Amerivantage ESRD (HMO-POS SNP)

HMOPOS Select Counties in Texas TX 377 Chronic or Disabling Condition

End Stage Renal

H2593 AMERIGROUP TEXAS, INC. Local CCP 037 0 Amerivantage Diabetes (HMO SNP)

HMO Harris County TX 27 Chronic or Disabling Condition

Diabetes Mellitus

H2593 AMERIGROUP TEXAS, INC. Local CCP 038 0 Amerivantage Heart (HMO SNP)

HMO Harris County TX 11 Chronic or Disabling Condition


H2593 AMERIGROUP TEXAS, INC. Local CCP 039 0 Amerivantage COPD (HMO SNP)

HMO Harris County TX Chronic or Disabling Condition


H2773 QUALITY HEALTH PLANS OF NEW YORK, INC.

Local CCP 003 0 Advantage Health LI - SNP (HMO SNP)

HMO Nassau, and Suffolk Counties NY 1,097 Chronic or Disabling Condition



Local CCP 017 0 Advantage Health NYC - SNP (HMO SNP)

HMO Queens County and Staten Island NY 121 Chronic or Disabling Condition


H2793 IMPERIAL INSURANCE COMPANY OF TEXAS, INC.

Local CCP 005 0 Imperial Insurance Company of Texas Value HMO SNP (HMO SNP)

HMO Counties: BX, DL, EP, HR, TR, TV TX 45 Chronic or Disabling Condition


H3132 AHF MCO OF FLORIDA, INC. Local CCP 001 0 PHP (HMO SNP) HMO Broward, Miami-Dade and Duval Counties, Florida

FL 1,530 Chronic or Disabling Condition

HIV Aids

H3240 AMERIGROUP NEW JERSEY, INC. Local CCP 017 0 Amerivantage ESRD (HMO-POS SNP)

HMOPOS Select Counties in New Jersey NJ 209 Chronic or Disabling Condition

End Stage Renal

H3362 INDEPENDENT HEALTH ASSOCIATION, INC.

Local CCP 035 0 Independent Health's Assure Advantage (HMO SNP)

HMO Erie County NY 156 Chronic or Disabling Condition

CHF Diabetes

H3447 HEALTHKEEPERS, INC. Local CCP 003 0 Anthem MediBlue COPD (HMO SNP)

HMO Richmond Metropolitan, West & So. of Richmond Area

VA 371 Chronic or Disabling Condition


H3447 HEALTHKEEPERS, INC. Local CCP 004 0 Anthem MediBlue Diabetes (HMO SNP)


VA 1,683 Chronic or Disabling Condition

Diabetes Mellitus

H3447 HEALTHKEEPERS, INC. Local CCP 017 0 Anthem MediBlue ESRD (HMO-POS SNP)

HMOPOS Select Counties in VA VA Chronic or Disabling Condition

End Stage Renal

SNP_2019_01A Page 4




Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH3572 AHF MCO OF GEORGIA, INC. Local CCP 001 0 PHP (HMO SNP) HMO Fulton County, Georgia GA 14 Chronic or

Disabling Condition

HIV Aids

H3815 ALIGNMENT HEALTH PLAN Local CCP 010 0 Alignment Health Plan Heart & Diabetes (HMO SNP)



H3930 SPARTAN PLAN NY, INC. Local CCP 002 0 Sunrise Advantage Plan C-SNP (HMO SNP)

HMO New York (partial) NY 25 Chronic or Disabling Condition

Dementia

H3949 BRAVO HEALTH PENNSYLVANIA, INC. Local CCP 024 0 Cigna-HealthSpring Achieve (HMO SNP)

HMO Select Pennsylvania Counties PA 2,427 Chronic or Disabling Condition

Diabetes Mellitus

H3962 KEYSTONE HEALTH PLAN CENTRAL, INC.

Local CCP 018 0 BlueJourney Alliance Lung Care (HMO SNP)

HMO Lancaster County PA Chronic or Disabling Condition



Local CCP 019 0 BlueJourney Alliance Heart and Diabetes Care (HMO SNP)

HMO Lancaster County PA Chronic or Disabling Condition


H4003 MMM HEALTHCARE, LLC Local CCP 009 0 MMM Supremo (HMO SNP)

HMO Puerto Rico PR 6,726 Chronic or Disabling Condition


H4140 DOCTORS HEALTHCARE PLANS, INC. Local CCP 003 0 DrCare (HMO-POS SNP)

HMOPOS Miami-Dade County FL Chronic or Disabling Condition

Chronic Heart Failure

H4140 DOCTORS HEALTHCARE PLANS, INC. Local CCP 004 0 DrExtra (HMO-POS SNP)

HMOPOS Miami-Dade County FL Chronic or Disabling Condition

Diabetes Mellitus

H4236 SPARTAN PLAN PA, INC. Local CCP 002 0 Sunrise Advantage Plan C-SNP (HMO SNP)

HMO Pennsylvania (partial) PA 62 Chronic or Disabling Condition

Dementia

H4346 HMO COLORADO, INC. Local CCP 005 0 Anthem Breathe (HMO SNP)

HMO Clark County NV 550 Chronic or Disabling Condition


H4346 HMO COLORADO, INC. Local CCP 006 0 Anthem Diabetes (HMO SNP)

HMO Clark County NV 1,974 Chronic or Disabling Condition

Diabetes Mellitus

H4346 HMO COLORADO, INC. Local CCP 008 0 Anthem Heart (HMO SNP)

HMO Clark County NV 473 Chronic or Disabling Condition


H4590 UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.

Local CCP 037 0 UnitedHealthcare Chronic Complete (HMO SNP)

HMO San Antonio Metro Area TX 6,677 Chronic or Disabling Condition

Cardiovascular Disorders, Chronic Heart Failure, Diabetes Mellitus

H4778 SPARTAN PLAN IL, INC. Local CCP 002 0 Sunrise Advantage Plan C-SNP (HMO SNP)

HMO Illinois (partial) IL 82 Chronic or Disabling Condition

Dementia

H5425 SCAN HEALTH PLAN Local CCP 028 0 Heart First (HMO SNP) HMO Orange County CA 680 Chronic or Disabling Condition


H5425 SCAN HEALTH PLAN Local CCP 033 0 Heart First (HMO SNP) HMO Riverside and San Bernardino Counties



H5425 SCAN HEALTH PLAN Local CCP 034 0 SCAN Balance (HMO SNP)


Diabetes Mellitus

SNP_2019_01A Page 5




Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH5425 SCAN HEALTH PLAN Local CCP 053 0 Heart First (HMO SNP) HMO Napa and Sonoma Counties CA 70 Chronic or

Disabling Condition


H5425 SCAN HEALTH PLAN Local CCP 054 0 SCAN Balance (HMO SNP)

HMO Napa and Sonoma Counties CA 113 Chronic or Disabling Condition

Diabetes Mellitus

H5425 SCAN HEALTH PLAN Local CCP 055 0 Scripps Heart First offered by SCAN Health Plan (HMO SNP)

HMO San Diego County CA 77 Chronic or Disabling Condition


H5427 FREEDOM HEALTH, INC. Local CCP 070 0 Freedom VIP Care (HMO SNP)

HMO Select Counties in Florida FL 4,180 Chronic or Disabling Condition


H5427 FREEDOM HEALTH, INC. Local CCP 072 0 Freedom VIP Savings (HMO SNP)



H5427 FREEDOM HEALTH, INC. Local CCP 077 0 Freedom VIP Savings COPD (HMO SNP)



H5427 FREEDOM HEALTH, INC. Local CCP 082 0 Freedom VIP Savings (HMO SNP)



H5427 FREEDOM HEALTH, INC. Local CCP 083 0 Freedom VIP Savings COPD (HMO SNP)

HMO Select Counties in Florida FL 447 Chronic or Disabling Condition


H5471 SIMPLY HEALTHCARE PLANS, INC. Local CCP 069 0 Simply Level (HMO SNP)

HMO Miami-Dade FL 1,933 Chronic or Disabling Condition

Diabetes Mellitus


HMO Polk FL 1,489 Chronic or Disabling Condition

Diabetes Mellitus


HMO Orange, Osceola, Seminole FL 732 Chronic or Disabling Condition

Diabetes Mellitus


HMO Hernando, Hillsborough, Pasco, Pinellas

FL 205 Chronic or Disabling Condition

Diabetes Mellitus


HMO Broward FL 134 Chronic or Disabling Condition

Diabetes Mellitus


HMO Palm Beach FL 50 Chronic or Disabling Condition

Diabetes Mellitus

H5496 IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.

Local CCP 005 0 Imperial Senior Value (HMO SNP) (HMO SNP)

HMO County: San Francisco & Los Angeles



H5591 MARTIN'S POINT GENERATIONS ADVANTAGE, INC.

Local CCP 007 0 Martin's Point Generations Advantage Focus DC (HMO SNP)

HMO Cumberland County ME 181 Chronic or Disabling Condition

Diabetes Mellitus

H5594 OPTIMUM HEALTHCARE, INC. Local CCP 028 0 Optimum Diamond Rewards (HMO SNP)



SNP_2019_01A Page 6




Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH5594 OPTIMUM HEALTHCARE, INC. Local CCP 029 0 Optimum Diamond

Rewards COPD (HMO SNP)






H5594 OPTIMUM HEALTHCARE, INC. Local CCP 031 0 Optimum Diamond Rewards COPD (HMO SNP)

HMO Select Counties in Florida FL 345 Chronic or Disabling Condition



HMO select counties in FL FL Chronic or Disabling Condition


H5594 OPTIMUM HEALTHCARE, INC. Local CCP 035 0 Optimum Diamond Rewards COPD (HMO SNP)

HMO select counties in FL FL Chronic or Disabling Condition


H5619 ARCADIAN HEALTH PLAN, INC. Local CCP 046 0 Humana Gold Plus - Diabetes and Heart (HMO SNP)

HMO Richmond - Tidewater Area VA 1,811 Chronic or Disabling Condition



HMO Select counties in Kentucky and Indiana

IN; KY 925 Chronic or Disabling Condition



HMO Upstate South Carolina SC 219 Chronic or Disabling Condition


H5649 CENTRAL HEALTH PLAN OF CALIFORNIA, INC.

Local CCP 006 0 Central Health Focus Plan (HMO SNP)

HMO Counties: LA, SB, and partial OC CA 2,232 Chronic or Disabling Condition


H5652 SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.

Local CCP 004 0 Erickson Advantage Champion (HMO-POS SNP)

HMOPOS Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA,NC

CO; KS; MA; MD; MI; NC; NJ; PA; TX; VA

1,543 Chronic or Disabling Condition

Cardiovascular Disorders, Chronic Heart Failure, Diabetes Mellitus

H5774 TRIPLE S ADVANTAGE, INC. Local CCP 022 0 Vital Plus (HMO SNP) HMO Puerto Rico PR 1,835 Chronic or Disabling Condition


H5852 AIDS HEALTHCARE FOUNDATION Local CCP 001 0 PHP (HMO SNP) HMO Los Angeles County, California CA 697 Chronic or Disabling Condition

HIV Aids

H5854 ANTHEM HEALTH PLANS, INC. Local CCP 012 0 Anthem MediBlue ESRD (HMO-POS SNP)

HMOPOS Select Counties in Connecticut CT Chronic or Disabling Condition

End Stage Renal

H5943 SCAN HEALTH PLAN Local CCP 001 0 VillageHealth (HMO-POS SNP)

HMOPOS Riverside and San Bernardino Counties


End Stage Renal

H5943 SCAN HEALTH PLAN Local CCP 002 0 VillageHealth (HMO-POS SNP)

HMOPOS Los Angeles and Orange Counties CA 736 Chronic or Disabling Condition

End Stage Renal

H6622 HUMANA WI HEALTH ORGANIZATION INSURANCE CORP


HMO Cincinnati and Columbus area KY; OH 2,721 Chronic or Disabling Condition




HMO Clark and Nye (partial) counties NV 6,422 Chronic or Disabling Condition


SNP_2019_01A Page 7




Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH6622 HUMANA WI HEALTH ORGANIZATION

INSURANCE CORPLocal CCP 030 0 Humana Gold Plus

SNP-CLD H6622-030 (HMO SNP)

HMO Clark and Nye (partial) counties NV 1,844 Chronic or Disabling Condition



Local CCP 031 0 Humana Kidney Care (HMO SNP)

HMO Clark and Nye (partial) counties NV 278 Chronic or Disabling Condition

End Stage Renal

H6672 EON HEALTH, INC. (GA) Local CCP 003 0 EON SILVER (HMO SNP)

HMO Select Georgia Counties GA 58 Chronic or Disabling Condition


H7802 SPARTAN PLAN VA, INC. Local CCP 002 0 Sunrise Advantage Plan C-SNP (HMO SNP)

HMO Virginia (partial) VA 33 Chronic or Disabling Condition

Dementia

H8170 AMERICA'S 1ST CHOICE OF SOUTH CAROLINA, INC.

Local CCP 002 0 AFC Special Care Rx (HMO SNP)

HMO Select Counties in SC SC 173 Chronic or Disabling Condition


H8552 ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY

Local CCP 028 0 Anthem MediBlue ESRD (PPO SNP)

Local PPO Select Counties in California CA 687 Chronic or Disabling Condition

End Stage Renal

H9403 EON HEALTH, INC. (SC) Local CCP 003 0 EON SILVER (HMO SNP)

HMO Select South Carolina Counties SC 41 Chronic or Disabling Condition


H9589 EON HEALTH, INC. (GA) Local CCP 001 0 EON GOLD (PPO SNP)

Local PPO Select Georgia Counties GA Chronic or Disabling Condition


R3444 CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.

Regional CCP 008 0 UnitedHealthcare Medicare Silver (Regional PPO SNP)

Regional PPO Arkansas and Missouri AR; MO 6,228 Chronic or Disabling Condition

CHF Diabetes


Regional CCP 009 0 UnitedHealthcare Medicare Gold (Regional PPO SNP)

Regional PPO Arkansas and Missouri AR; MO 17,407 Chronic or Disabling Condition


R6801 CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY


Regional PPO Texas TX 8,071 Chronic or Disabling Condition

CHF Diabetes

R6801 CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY


Regional PPO Texas TX 30,970 Chronic or Disabling Condition


R7444 UNITEDHEALTHCARE INSURANCE COMPANY


Regional PPO Georgia and South Carolina GA; SC 26,398 Chronic or Disabling Condition

CHF Diabetes



Regional PPO Georgia and South Carolina GA; SC 64,122 Chronic or Disabling Condition


Under-11 38 Chronic or Disabling Condition

H0028 CHA HMO, INC. Local CCP 007 0 Humana Gold Plus SNP-DE H0028-007 (HMO SNP)

HMO Douglas County NE 107 Dual-Eligible


HMO Select counties in Missouri MO 3,160 Dual-Eligible


HMO Select Counties in Texas TX 4,692 Dual-Eligible

SNP_2019_01A Page 8




Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH0028 CHA HMO, INC. Local CCP 032 0 Humana Gold Plus

SNP-DE H0028-032 (HMO SNP)

HMO Select Counties in Texas TX 747 Dual-Eligible


HMO Fort Bend, Harris and Montgomery counties

TX 282 Dual-Eligible


HMO El Paso County TX 62 Dual-Eligible


HMO Corpus Christi/San Antonio area TX 2,317 Dual-Eligible

H0154 VIVA HEALTH, INC. Local CCP 012 0 VIVA Medicare Extra Value (HMO SNP)

HMO Northwest, Central, and South Alabama

AL 18,481 Dual-Eligible

H0169 UNITEDHEALTHCARE OF THE MIDWEST, INC.

Local CCP 001 0 UnitedHealthcare Dual Complete (HMO SNP)

HMO Select Counties in Iowa IA 9,465 Dual-Eligible



HMO Select Counties in Missouri MO 8,016 Dual-Eligible



HMO Select Counties in Nebraska NE 5,010 Dual-Eligible

H0174 WELLCARE OF TEXAS, INC. Local CCP 001 0 WellCare TexanPlus Star (HMO SNP)

HMO Select counties in Southeast Texas TX 855 Dual-Eligible

H0174 WELLCARE OF TEXAS, INC. Local CCP 004 0 WellCare Access (HMO SNP)

HMO Select Counties in TX TX 9,750 Dual-Eligible

H0174 WELLCARE OF TEXAS, INC. Local CCP 006 0 WellCare Liberty (HMO SNP)

HMO Select Counties in TX TX 2,916 Dual-Eligible

H0251 UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.


HMO Select Counties in Tennessee TN 59,270 Dual-Eligible


Local CCP 004 0 UnitedHealthcare Dual Complete ONE (HMO SNP)

HMO Select Counties in Tennessee TN 1,679 Dual-Eligible FIDE SNP


Local CCP 005 0 UnitedHealthcare Dual Complete ONE Plus (HMO SNP)

HMO Select Counties in Tennessee TN 79 Dual-Eligible

H0271 SYMPHONIX HEALTH INSURANCE, INC.

Local CCP 005 0 UnitedHealthcare Dual Complete (PPO SNP)

Local PPO Select Counties in Indiana IN 1,765 Dual-Eligible



Local PPO Select Counties in Maine ME 859 Dual-Eligible



Local PPO Select Counties in West Virginia WV 551 Dual-Eligible



Local PPO State of Connecticut CT 7,440 Dual-Eligible

H0321 ARIZONA PHYSICIANS IPA, INC. Local CCP 002 0 UnitedHealthcare Dual Complete (HMO SNP)

HMO Select counties in Arizona AZ 38,849 Dual-Eligible

H0321 ARIZONA PHYSICIANS IPA, INC. Local CCP 004 0 UnitedHealthcare Dual Complete ONE (HMO SNP)

HMO Select counties in Arizona AZ 3,256 Dual-Eligible FIDE SNP

H0423 METROPLUS HEALTH PLAN, INC. Local CCP 001 0 MetroPlus Advantage Plan (HMO SNP)

HMO NYC - All five boroughs NY 7,456 Dual-Eligible

H0432 UNITEDHEALTHCARE OF ALABAMA, INC.


HMO Select Counties in Alabama AL 5,111 Dual-Eligible

H0439 CIGNA HEALTHCARE OF GEORGIA, INC.

Local CCP 002 0 Cigna-HealthSpring TotalCare (HMO SNP)

HMO Select Georgia Counties GA 4,683 Dual-Eligible

SNP_2019_01A Page 9




Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH0524 KAISER FOUNDATION HP, INC. Local CCP 029 0 Senior Advantage

Medicare Medi-Cal Plan South (HMO SNP)

HMO Southern California Plan CA 32,517 Dual-Eligible

H0524 KAISER FOUNDATION HP, INC. Local CCP 030 0 Senior Advantage Medicare Medi-Cal Plan North (HMO SNP)

HMO Northern California Plan CA 42,895 Dual-Eligible

H0544 BLUE CROSS OF CALIFORNIA Local CCP 003 0 Anthem Connect (HMO SNP)

HMO Los Angeles County CA 85 Dual-Eligible

H0544 BLUE CROSS OF CALIFORNIA Local CCP 041 0 Anthem Connect (HMO SNP)

HMO Santa Clara County CA 20 Dual-Eligible

H0544 BLUE CROSS OF CALIFORNIA Local CCP 052 0 Anthem MediBlue Dual Advantage (HMO SNP)

HMO Fresno, Kings, Madera and Tulare Counties

CA 879 Dual-Eligible


HMO Kern County CA 877 Dual-Eligible


HMO San Francisco and Sacramento Counties

CA 6,626 Dual-Eligible


HMO Ventura County CA 938 Dual-Eligible

H0544 BLUE CROSS OF CALIFORNIA Local CCP 087 0 Anthem MediBlue Dual Plus (HMO SNP)

HMO Fresno, Kings, Madera, Tulare CA 47 Dual-Eligible


HMO Kern CA 48 Dual-Eligible


HMO San Francisco and Sacramento CA 700 Dual-Eligible


HMO Ventura CA 23 Dual-Eligible

H0562 HEALTH NET OF CALIFORNIA,INC. Local CCP 055 0 Health Net Seniority Plus Amber I (HMO SNP)

HMO L.A., Kern, Org, Riv, SB, Fresno, SD, SF, Tulare


H0562 HEALTH NET OF CALIFORNIA,INC. Local CCP 110 1 Health Net Seniority Plus Amber II (HMO SNP)

HMO Parts of Southern and Northern California








H0571 CHINESE COMMUNITY HEALTH PLAN Local CCP 005 0 CCHP Senior Select Program (HMO SNP)

HMO San Francisco County CA 2,829 Dual-Eligible

H0624 UNITEDHEALTHCARE INSURANCE COMPANY


HMO Denver and Colorado Springs metro areas

CO 8,639 Dual-Eligible

H0630 KAISER FOUNDATION HP OF CO Local CCP 014 0 Senior Advantage Medicare Medicaid (HMO SNP)

HMO Denver Metro Area CO 2,908 Dual-Eligible

H0712 WELLCARE OF CONNECTICUT, INC. Local CCP 005 0 WellCare Access (HMO SNP)

HMO Select Counties in CT CT 3,049 Dual-Eligible

SNP_2019_01A Page 10




Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH0712 WELLCARE OF CONNECTICUT, INC. Local CCP 025 0 WellCare Access (HMO

SNP)HMO Select Counties in NC NC 242 Dual-Eligible

H0712 WELLCARE OF CONNECTICUT, INC. Local CCP 028 0 WellCare Liberty (HMO SNP)

HMO Select Counties in CT CT 126 Dual-Eligible

H0838 UNIVERSAL CARE, INC. Local CCP 024 0 Brand New Day Dual Access Plan (HMO SNP)

HMO FRE IMP KER KIN LA ORA RIV SBD TUL


H0908 BUCKEYE COMMUNITY HEALTH PLAN, INC.

Local CCP 001 0 Allwell Dual Medicare (HMO SNP)

HMO Statewide OH 724 Dual-Eligible

H0913 WELLCARE HEALTH PLANS OF NEW JERSEY, INC.

Local CCP 013 0 WellCare Liberty (HMO SNP)

HMO Select Counties in NJ NJ 3,202 Dual-Eligible FIDE SNP

H0982 SOLIS HEALTH PLANS, INC. Local CCP 002 0 SOLIS SPF 002 (HMO SNP)

HMO Miami-Dade D-SNP FL 271 Dual-Eligible


HMO Orange D-SNP FL 16 Dual-Eligible


HMO Hillsborough D-SNP FL Dual-Eligible

H1019 CAREPLUS HEALTH PLANS, INC. Local CCP 023 0 CareNeeds PLUS (HMO SNP)

HMO Broward and Palm Beach counties FL 2,804 Dual-Eligible


HMO Miami-Dade County FL 9,233 Dual-Eligible


HMO Hillsborough, Pasco, Pinellas and Polk counties

FL 3,570 Dual-Eligible


HMO Select local counties FL 3,610 Dual-Eligible


HMO Duval County FL 268 Dual-Eligible

H1019 CAREPLUS HEALTH PLANS, INC. Local CCP 077 0 CareNeeds (HMO SNP)

HMO Select local counties FL 9,564 Dual-Eligible


HMO Hillsborough, Pasco, Pinellas and Polk counties



HMO Broward and Palm Beach counties FL 5,449 Dual-Eligible




HMO Duval County FL 1,117 Dual-Eligible


HMO Brevard and Indian River counties FL 172 Dual-Eligible


HMO Brevard and Indian River counties FL 778 Dual-Eligible

H1032 WELLCARE OF FLORIDA, INC. Local CCP 061 0 WellCare Select (HMO SNP)

HMO Select Counties in FL FL 3,170 Dual-Eligible

H1032 WELLCARE OF FLORIDA, INC. Local CCP 124 0 WellCare Access (HMO SNP)


H1032 WELLCARE OF FLORIDA, INC. Local CCP 170 0 WellCare Access (HMO SNP)

HMO Miami-Dade County FL 219 Dual-Eligible

H1032 WELLCARE OF FLORIDA, INC. Local CCP 175 0 WellCare Liberty (HMO SNP)


H1032 WELLCARE OF FLORIDA, INC. Local CCP 176 0 WellCare Liberty (HMO SNP)


H1032 WELLCARE OF FLORIDA, INC. Local CCP 182 0 WellCare Select (HMO SNP)






Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH1032 WELLCARE OF FLORIDA, INC. Local CCP 197 0 WellCare Reserve

(HMO SNP)HMO Select Counties in FL FL Dual-Eligible

H1032 WELLCARE OF FLORIDA, INC. Local CCP 202 0 WellCare Reserve (HMO SNP)

HMO Select Counties in FL FL 193 Dual-Eligible


HMO Select Counties in FL FL Dual-Eligible





H1035 HEALTH OPTIONS, INC. Local CCP 027 0 BlueMedicare Complete (HMO SNP)



HMO Broward and Palm Beach counties FL 263 Dual-Eligible


HMO Orange County FL 87 Dual-Eligible


HMO Hillsborough and Polk counties FL 42 Dual-Eligible

H1036 HUMANA MEDICAL PLAN, INC. Local CCP 077 0 Humana Gold Plus SNP-DE H1036-077A (HMO SNP)


H1036 HUMANA MEDICAL PLAN, INC. Local CCP 102 0 Humana Gold Plus SNP-DE H1036-102 (HMO SNP)

HMO Tampa Metro Area FL 3,763 Dual-Eligible


HMO Broward County FL 4,792 Dual-Eligible


HMO Palm Beach County FL 2,360 Dual-Eligible


HMO Charlotte Metro Area NC 3,931 Dual-Eligible


HMO Greensboro / Winston-Salem Metro Area

NC 3,209 Dual-Eligible


HMO Flagler and Volusia counties FL 1,023 Dual-Eligible


HMO Jacksonville Area FL 971 Dual-Eligible


HMO Greater Orlando FL 1,651 Dual-Eligible


HMO Bay, Escambia, Santa Rosa and Walton counties

FL 633 Dual-Eligible


HMO Select Counties in Mississippi MS 3,868 Dual-Eligible


HMO Glades, Martin, Okeechobee and St. Lucie counties






Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH1036 HUMANA MEDICAL PLAN, INC. Local CCP 231 0 Humana Gold Plus

SNP-DE H1036-231 (HMO SNP)

HMO Hardee, Highlands and Polk counties


H1036 HUMANA MEDICAL PLAN, INC. Local CCP 235 0 Humana Community HMO SNP-DE (HMO SNP)

HMO Jefferson County KY 263 Dual-Eligible


HMO Flagler and Volusia counties FL 4,177 Dual-Eligible


HMO Jacksonville Area FL 3,795 Dual-Eligible


HMO Bay, Escambia, Santa Rosa and Walton counties



HMO Greater Orlando FL 4,919 Dual-Eligible


HMO Glades, Martin, Okeechobee and St. Lucie counties



HMO Tampa Metro Area FL 11,181 Dual-Eligible


HMO Hardee, Highlands and Polk counties



HMO Broward County FL 6,408 Dual-Eligible




HMO Palm Beach County FL 4,336 Dual-Eligible


HMO Sarasota County FL 74 Dual-Eligible


HMO Sarasota County FL 264 Dual-Eligible


HMO Raleigh Metro Area NC 133 Dual-Eligible

H1045 PREFERRED CARE PARTNERS, INC. Local CCP 012 0 Preferred Medicare Assist (HMO SNP)

HMO Miami-Dade and Broward Counties FL 14,255 Dual-Eligible

H1045 PREFERRED CARE PARTNERS, INC. Local CCP 038 0 Preferred Medicare Assist Palm Beach (HMO SNP)

HMO Palm Beach county FL 1,032 Dual-Eligible

H1045 PREFERRED CARE PARTNERS, INC. Local CCP 039 0 UnitedHealthcare Dual Complete LP (HMO SNP)

HMO Select counties in Central Florida FL 6,299 Dual-Eligible





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH1112 WELLCARE OF GEORGIA, INC. Local CCP 006 0 WellCare Access (HMO

SNP)HMO Select Counties in GA GA 14,548 Dual-Eligible

H1112 WELLCARE OF GEORGIA, INC. Local CCP 033 0 WellCare Liberty (HMO SNP)

HMO Select Counties in GA GA 3,690 Dual-Eligible

H1170 KAISER FOUNDATION HP OF GA, INC. Local CCP 008 0 Senior Advantage Medicare Medicaid Plan (HMO SNP)

HMO Atlanta Metro Area GA 1,177 Dual-Eligible

H1205 INTEGRA MLTC, INC. Local CCP 001 0 Integra Harmony Plan (HMO SNP)

HMO Bronx, Kings, Queens and New York counties

NY Dual-Eligible

H1205 INTEGRA MLTC, INC. Local CCP 002 0 Integra Synergy Plan (HMO SNP)

HMO Bronx, Kings, Queens and New York counties

NY Dual-Eligible

H1205 INTEGRA MLTC, INC. Local CCP 005 0 Integra Harmony Plan (HMO SNP)

HMO Nassau County NY Dual-Eligible

H1205 INTEGRA MLTC, INC. Local CCP 006 0 Integra Synergy Plan (HMO SNP)

HMO Nassau County NY Dual-Eligible

H1230 KAISER FOUNDATION HP, INC. Local CCP 008 0 Senior Advantage Medicare Medicaid (HMO SNP)

HMO Islands of Oahu and Maui HI 476 Dual-Eligible

H1350 BLUE CROSS OF IDAHO CARE PLUS, INC.

Local CCP 009 0 True Blue Special Needs Plan (HMO SNP)

HMO Select Counties in Idaho ID 3,895 Dual-Eligible FIDE SNP

H1416 HARMONY HEALTH PLAN, INC. Local CCP 033 0 WellCare Access (HMO SNP)

HMO Select Counties in AR AR 3,998 Dual-Eligible


HMO Select Counties in MS MS 10,099 Dual-Eligible


HMO Select Counties in TN TN 4,255 Dual-Eligible


HMO Select Counties in SC SC 2,265 Dual-Eligible

H1416 HARMONY HEALTH PLAN, INC. Local CCP 043 0 WellCare Liberty (HMO SNP)

HMO Select Counties in AR AR 1,468 Dual-Eligible

H1416 HARMONY HEALTH PLAN, INC. Local CCP 044 0 WellCare Liberty (HMO SNP)

HMO Select Counties in MS MS 1,990 Dual-Eligible

H1436 ABSOLUTE TOTAL CARE, INC. Local CCP 005 0 Allwell Dual Medicare (HMO SNP)

HMO Statewide SC 398 Dual-Eligible

H1436 ABSOLUTE TOTAL CARE, INC. Local CCP 006 0 Allwell Dual Medicare Essentials (HMO SNP)

HMO Statewide SC 33 Dual-Eligible

H1587 ARKANSAS SUPERIOR SELECT, INC. Local CCP 001 0 Tribute (HMO-POS SNP)

HMOPOS Arkansas AR 1,422 Dual-Eligible

H1609 AETNA HEALTH INC. (FL) Local CCP 015 0 Coventry Medicare Vista Plan (HMO SNP)

HMO South FL FL 617 Dual-Eligible

H1609 AETNA HEALTH INC. (FL) Local CCP 017 0 Coventry Medicare Summit Plan (HMO SNP)

HMO South FL FL 12,978 Dual-Eligible


HMO South FL, Treasure Coast FL, West FL


H1609 AETNA HEALTH INC. (FL) Local CCP 023 0 Aetna Medicare Select Plan (HMO SNP)

HMO Central FL FL 707 Dual-Eligible


HMO North FL FL 50 Dual-Eligible

H1609 AETNA HEALTH INC. (FL) Local CCP 040 0 Aetna Medicare Select Plan (HMO SNP)

HMO Southwest FL FL 22 Dual-Eligible





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH1610 COVENTRY HEALTH CARE OF

VIRGINIALocal CCP 001 0 Aetna Better Health,

Inc. (HMO SNP)HMO Virginia VA 1,506 Dual-Eligible

H1664 HOME STATE HEALTH PLAN, INC. Local CCP 005 0 Allwell Dual Medicare (HMO SNP)

HMO 21 counties in West and South Missouri

MO 19 Dual-Eligible

H1894 AMERIGROUP WASHINGTON, INC. Local CCP 002 0 Amerivantage Dual Coordination (HMO SNP)

HMO Select counties in Washington WA 233 Dual-Eligible


Local CCP 032 0 Humana Gold Plus SNP-DE H1951-032 (HMO SNP)

HMO Baton Rouge Area LA 3,522 Dual-Eligible



HMO New Orleans Area LA 4,846 Dual-Eligible



HMO Washington and St. Tammany Parishes

LA 1,209 Dual-Eligible



HMO Select Louisiana Parishes LA 7,807 Dual-Eligible

H1961 PEOPLES HEALTH, INC. Local CCP 003 0 Peoples Health Secure Health (HMO SNP)

HMO South Louisiana LA 20,961 Dual-Eligible

H1961 PEOPLES HEALTH, INC. Local CCP 011 0 Peoples Health Secure Choice #011 (HMO SNP)

HMO North and Central Louisiana LA 33 Dual-Eligible

H2034 COMMUNITY CARE HEALTH PLAN, INC.

Local CCP 001 0 Community Care's Partnership Program (HMO SNP)

HMO Eastern Wisconsin WI 359 Dual-Eligible FIDE SNP

H2034 COMMUNITY CARE HEALTH PLAN, INC.

Local CCP 002 0 Community Care's Partnership Program Disabled (HMO SNP)

HMO Eastern Wisconsin WI 114 Dual-Eligible FIDE SNP

H2108 BRAVO HEALTH MID-ATLANTIC, INC. Local CCP 001 0 Cigna-HealthSpring TotalCare (HMO SNP)

HMO Maryland, Washington DC and Delaware Counties

DC; DE; MD 4,420 Dual-Eligible

H2134 WESTERN SKY COMMUNITY CARE, INC.


HMO Bernalillo, Cibola, Sandoval, Valencia

NM Dual-Eligible

H2168 VILLAGE SENIOR SERVICES CORPORATION

Local CCP 001 0 VillageCareMAX Medicare Health Advantage (HMO SNP)

HMO Bronx, Kings, New York, Queens NY 295 Dual-Eligible

H2168 VILLAGE SENIOR SERVICES CORPORATION

Local CCP 002 0 VillageCareMAX Medicare Total Advantage (HMO SNP)

HMO Bronx, Kings, New York, Queens NY 1,005 Dual-Eligible FIDE SNP

H2174 TRILLIUM COMMUNITY HEALTH PLAN Local CCP 001 0 Trillium Advantage Dual (HMO SNP)

HMO Lane County OR 2,508 Dual-Eligible

H2224 SENIOR WHOLE HEALTH, LLC Local CCP 001 0 Senior Whole Health (HMO SNP)

HMO Brstl, Essx, Hmpdn, Mdlsx, Nrflk, Plmth, Sflk, Wor

MA 7,892 Dual-Eligible FIDE SNP

H2224 SENIOR WHOLE HEALTH, LLC Local CCP 003 0 Senior Whole Health NHC (HMO SNP)

HMO Brstl, Essx, Hmpdn, Mdlsx, Nrflk, Plmth, Sflk, Wor


H2225 COMMONWEALTH CARE ALLIANCE, INC.

Local CCP 001 0 Senior Care Options Program (HMO SNP)

HMO BRI, ESS, FRA, HMD, HMP, MID, NOR, PLY, SUF, WOR



Local CCP 001 0 UnitedHealthcare Senior Care Options (HMO SNP)

HMO Boston, Springfield and Worcester Metro Areas






Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH2228 UNITEDHEALTHCARE INSURANCE

COMPANYLocal CCP 041 0 UnitedHealthcare Dual

Complete (PPO SNP)Local PPO El Paso County TX 13,753 Dual-Eligible



Local PPO Dona Ana, Grant, Hidalgo, Luna and Sierra counties

NM 6,558 Dual-Eligible



Local PPO Honolulu County HI 11,307 Dual-Eligible



Local PPO Atlanta and Macon Metro Areas GA 11,305 Dual-Eligible



Local PPO Washington, DC DC 8,392 Dual-Eligible



Local PPO Bernalillo, Sandoval, Santa Fe, Valencia Counties

NM 10,094 Dual-Eligible

H2237 INDEPENDENT CARE HEALTH PLAN, INC.

Local CCP 001 0 iCare Medicare Plan (HMO SNP)

HMO Eastern, South Central and Western Wisconsin

WI 6,940 Dual-Eligible


Local CCP 007 0 iCare Family Care Partnership (HMO SNP)

HMO Milwaukee, Racine, Kenosha, Dane and Sauk Counties

WI 655 Dual-Eligible FIDE SNP


Local CCP 009 0 Aurora CompleteCare (HMO SNP)

HMO Milwaukee, Waukesha and SE Wis. Counties

WI 370 Dual-Eligible


Local CCP 010 0 Lakeland Care +Health (HMO SNP)

HMO Northeast Wisconsin WI 25 Dual-Eligible

H2247 UNITEDHEALTHCARE COMMUNITY PLAN, INC.


HMO Select Counties in MI MI 922 Dual-Eligible

H2256 TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION

Local CCP 029 0 Tufts Health Plan Senior Care Options (HMO SNP)

HMO Most of Massachusetts MA 4,507 Dual-Eligible FIDE SNP

H2288 BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK

Local CCP 003 0 Bright Advantage Special Care (HMO SNP)

HMO New York County NY Dual-Eligible

H2354 HEALTH ALLIANCE PLAN OF MICHIGAN

Local CCP 025 0 HAP Empowered Duals (HMO SNP)

HMO Genesee County MI Dual-Eligible

H2416 PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE

Local CCP 001 0 PrimeWest Senior Health Complete (HMO SNP)

HMO Northern, west central, and southwestern Minnesota

MN 1,966 Dual-Eligible FIDE SNP

H2417 ITASCA MEDICAL CARE Local CCP 001 0 IMCare Classic (HMO SNP)

HMO Itasca County MN 471 Dual-Eligible FIDE SNP

H2419 SOUTH COUNTRY HEALTH ALLIANCE Local CCP 001 0 SeniorCare Complete (HMO SNP)

HMO Select Counties in Minnesota MN 1,855 Dual-Eligible FIDE SNP

H2422 HEALTHPARTNERS, INC. Local CCP 002 0 HealthPartners Minnesota Senior Health Options (HMO SNP)

HMO Minneapolis/St. Paul Metro Area MN 3,244 Dual-Eligible FIDE SNP

H2425 BLUE PLUS Local CCP 001 0 SecureBlue (HMO SNP)

HMO 62 Counties within the State of Minnesota


H2456 UCARE MINNESOTA Local CCP 002 0 UCare's Minnesota Senior Health Options (HMO SNP)

HMO Twin Cities Metropolitan area and Greater MN


H2458 MEDICA HEALTH PLANS Local CCP 002 0 Medica DUAL Solution (HMO SNP)

HMO Specific Minnesota Counties MN 11,088 Dual-Eligible FIDE SNP

H2491 WELLCARE HEALTH INSURANCE OF ARIZONA, INC.

Local CCP 004 0 'Ohana Liberty (HMO SNP)

HMO Hawaii, Honolulu, Kauai, Maui Counties

HI 4,565 Dual-Eligible

H2491 WELLCARE HEALTH INSURANCE OF ARIZONA, INC.

Local CCP 006 0 WellCare Access (HMO SNP)

HMO Select Counties in LA LA 6,529 Dual-Eligible





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH2491 WELLCARE HEALTH INSURANCE OF

ARIZONA, INC.Local CCP 008 0 WellCare Liberty (HMO

SNP)HMO Select Counties in LA LA 3,264 Dual-Eligible

H2563 OPTIMA HEALTH PLAN Local CCP 004 0 Optima Community Complete (HMO SNP)

HMO Virginia VA 74 Dual-Eligible

H2593 AMERIGROUP TEXAS, INC. Local CCP 021 0 Amerivantage Dual Coordination (HMO SNP)

HMO Select Counties in Tennessee TN 9,608 Dual-Eligible













H2593 AMERIGROUP TEXAS, INC. Local CCP 032 0 Amerivantage Dual Premier (HMO SNP)

HMO Houston Area TX 7,484 Dual-Eligible

H2593 AMERIGROUP TEXAS, INC. Local CCP 033 0 Amerivantage Dual Secure (HMO SNP)

HMO Dallas-Fort Worth TX 34 Dual-Eligible


HMO San Antonio Area TX 20 Dual-Eligible


HMO El Paso Area TX Dual-Eligible


HMO Austin Area TX Dual-Eligible


Local CCP 018 0 Advantage Value One NY - Dual (HMO SNP)

HMO Nassau, Queens, Staten Island and Suffolk Counties

NY 45 Dual-Eligible

H2793 IMPERIAL INSURANCE COMPANY OF TEXAS, INC.

Local CCP 004 0 Imperial Insurance Company of Texas Dual (HMO SNP) (HMO SNP)

HMO Counties: BX, DL, EP, HR, TR, TV TX Dual-Eligible

H2802 UNITEDHEALTHCARE OF THE MIDLANDS, INC.


HMO Select Counties in Alabama AL 18,511 Dual-Eligible

H2879 MOLINA HEALTHCARE OF WISCONSIN, INC.

Local CCP 001 0 Molina Medicare Options Plus (HMO SNP)

HMO Milwaukee WI 947 Dual-Eligible

H2915 PENNSYLVANIA HEALTH & WELLNESS, INC.


HMO Southwestern Zone PA 346 Dual-Eligible



HMO Southeastern Zone PA 38 Dual-Eligible



HMO SE PA Counties PA Dual-Eligible



HMO NW PA Counties PA Dual-Eligible





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH2926 PRIMEWEST RURAL MN HEALTH

CARE ACCESS INITIATIVELocal CCP 001 0 Prime Health Complete

(HMO SNP)HMO Northern, west central, and

southwestern MinnesotaMN 181 Dual-Eligible

H3054 CONSTELLATION HEALTH, LLC. Local CCP 001 0 Genesis Constellation Health (HMO SNP)

HMO Puerto Rico PR 3,328 Dual-Eligible PBP A Platino YN

H3054 CONSTELLATION HEALTH, LLC. Local CCP 003 0 Genesis Prime Constellation Health (HMO SNP)


H3054 CONSTELLATION HEALTH, LLC. Local CCP 004 0 Genesis @ Home Constellation Health (HMO SNP)

HMO Puerto Rico PR 354 Dual-Eligible PBP A Platino YN

H3113 OXFORD HEALTH PLANS (NJ), INC. Local CCP 005 0 UnitedHealthcare Dual Complete ONE (HMO SNP)

HMO Select counties in New Jersey NJ 22,130 Dual-Eligible FIDE SNP

H3113 OXFORD HEALTH PLANS (NJ), INC. Local CCP 009 0 UnitedHealthcare Dual Complete (HMO SNP)

HMO Select counties in Pennsylvania PA 14,211 Dual-Eligible


HMO State of Rhode Island RI 3,041 Dual-Eligible


HMO Kent, New Castle, and Sussex Counties

DE 1,930 Dual-Eligible

H3113 OXFORD HEALTH PLANS (NJ), INC. Local CCP 012 0 UnitedHealthcare Dual Complete ONE (HMO SNP)

HMO Select Counties in Pennsylvania PA 72 Dual-Eligible

H3204 PRESBYTERIAN HEALTH PLAN Local CCP 012 0 Presbyterian Dual Plus (HMO SNP)

HMO Bernalilo, Sandoval, Torrance, Valencia

NM 309 Dual-Eligible

H3227 KALOS HEALTH, INC. Local CCP 001 0 Kalos Health Gold Plus (HMO SNP)

HMO Western New York NY 113 Dual-Eligible

H3239 AETNA BETTER HEALTH, INC. (LA) Local CCP 001 0 Aetna Medicare Dual Preferred (HMO SNP)

HMO Select Louisiana Parishes LA 49 Dual-Eligible

H3240 AMERIGROUP NEW JERSEY, INC. Local CCP 013 0 Amerivantage Dual Coordination (HMO SNP)

HMO Eastern and Central New Jersey NJ 8,447 Dual-Eligible FIDE SNP

H3240 AMERIGROUP NEW JERSEY, INC. Local CCP 016 0 Amerivantage Dual Coordination (HMO SNP)

HMO Select Counties in New Jersey NJ 812 Dual-Eligible FIDE SNP

H3259 VOLUNTEER STATE HEALTH PLAN Local CCP 001 0 BlueCare Plus (HMO SNP)

HMO Tennessee TN 16,338 Dual-Eligible

H3276 CONNECTICARE INSURANCE COMPANY, INC.

Local CCP 001 0 ConnectiCare Passage Dual (HMO SNP)

HMO State of Connecticut CT 25 Dual-Eligible

H3291 PRUITTHEALTH PREMIER, INC. Local CCP 002 0 PruittHealth Premier D-SNP (HMO SNP)

HMO GA (Clarke County) GA Dual-Eligible

H3293 MMM OF FLORIDA, INC. Local CCP 004 0 MMM - PLATINUM (HMO SNP)

HMO Counties: Miami-Dade, Broward, Palm Beach


H3328 THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.

Local CCP 002 0 Fidelis Dual Advantage (HMO SNP)

HMO NY Counties NY 1,336 Dual-Eligible


Local CCP 016 0 Fidelis Medicaid Advantage Plus (HMO SNP)

HMO NY Counties NY 92 Dual-Eligible FIDE SNP


Local CCP 017 0 Fidelis Dual Advantage Flex (HMO SNP)

HMO NY Counties NY 36,403 Dual-Eligible

H3330 HEALTH INSURANCE PLAN OF GREATER NEW YORK

Local CCP 042 3 EmblemHealth VIP Dual (HMO SNP)

HMO NYC, Long Island and Lower Hudson Valley Counties

NY 3,170 Dual-Eligible





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH3330 HEALTH INSURANCE PLAN OF

GREATER NEW YORKLocal CCP 042 1 EmblemHealth VIP

Dual (HMO SNP)HMO NYC, Long Island and Lower

Hudson Valley CountiesNY 11,396 Dual-Eligible


Local CCP 042 2 EmblemHealth VIP Dual (HMO SNP)




Local CCP 818 0 EmblemHealth VIP Dual Group (HMO SNP)


NY 54 Dual-Eligible

H3347 ELDERPLAN, INC. Local CCP 002 0 Elderplan For Medicaid Beneficiaries (HMO SNP)

HMO Brx, Ki, Na, NY, Qu, Wes NY 4,639 Dual-Eligible

H3347 ELDERPLAN, INC. Local CCP 007 0 Elderplan Plus Long Term Care (HMO SNP)

HMO Brx, Ki, Na, NY, Qu, Ri, Wes NY 1,420 Dual-Eligible FIDE SNP

H3359 HEALTHFIRST HEALTH PLAN, INC. Local CCP 021 0 Healthfirst Life Improvement Plan (HMO SNP)

HMO New York City, Nassau and Westchester Counties


H3359 HEALTHFIRST HEALTH PLAN, INC. Local CCP 034 0 Healthfirst CompleteCare (HMO SNP)

HMO New York City, Nassau, and Westchester Counties

NY 8,782 Dual-Eligible FIDE SNP

H3387 UNITEDHEALTHCARE OF NEW YORK, INC.


HMO Select Counties in New York NY 100,738 Dual-Eligible

H3447 HEALTHKEEPERS, INC. Local CCP 011 0 Anthem MediBlue Dual Advantage (HMO SNP)

HMO Select Counties in Virginia VA 3,007 Dual-Eligible


HMO Select Counties in Virginia VA 1,376 Dual-Eligible


HMO Select Counties in Missouri MO 2,991 Dual-Eligible


HMO Select Counties in Indiana IN 9,006 Dual-Eligible

H3499 COORDINATED CARE CORPORATION Local CCP 005 0 Allwell Dual Medicare (HMO SNP)

HMO 23 counties in No., Central and So. Indiana

IN 63 Dual-Eligible

H3533 HUMANA HEALTH COMPANY OF NEW YORK, INC.



H3533 HUMANA HEALTH COMPANY OF NEW YORK, INC.



H3561 HEALTH NET COMMUNITY SOLUTIONS, INC.

Local CCP 001 0 Health Net Seniority Plus Amber II Premier (HMO SNP)

HMO Fresno County CA 159 Dual-Eligible

H3655 COMMUNITY INSURANCE COMPANY Local CCP 033 0 Anthem MediBlue Dual Advantage (HMO SNP)

HMO Select Counties in Ohio OH 17,102 Dual-Eligible

H3672 THE HEALTH PLAN OF WEST VIRGINIA Local CCP 019 0 The Health Plan SecureCare SNP (HMO SNP)

HMO Southeastern Ohio, West Virginia OH; WV 2,647 Dual-Eligible


Local CCP 002 0 UnitedHealthcare Dual Complete LP1 (HMO SNP)

HMO Select Counties in Wisconsin WI 8,671 Dual-Eligible





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH3811 SAMARITAN HEALTH PLANS, INC. Local CCP 003 0 Samaritan Advantage

Special Needs Plan (HMO SNP)

HMO Benton, Linn and Lincoln counties OR 1,496 Dual-Eligible

H3814 ATRIO HEALTH PLANS Local CCP 007 0 ATRIO Special Needs Plan (HMO SNP)

HMO Douglas and Klamath Counties OR 2,051 Dual-Eligible

H3822 HEALTH CARE SERVICE CORPORATION

Local CCP 006 0 Blue Cross Medicare Advantage Dual Care (HMO SNP)

HMO Bernalillo, Sandoval, Torrance and Valencia

NM 509 Dual-Eligible

H3832 HAWAII MEDICAL SERVICE ASSOCIATION

Local CCP 011 0 HMSA Akamai Advantage Dual Care (PPO SNP)

Local PPO Hawaii, Kalawao, Kauai, Maui and Honolulu counties

HI 275 Dual-Eligible

H3949 BRAVO HEALTH PENNSYLVANIA, INC. Local CCP 009 0 Cigna-HealthSpring TotalCare (HMO SNP)

HMO Select Pennsylvania Counties PA 17,862 Dual-Eligible

H3954 GEISINGER HEALTH PLAN Local CCP 097 0 Geisinger Gold Secure Rx (HMO SNP)

HMO Pennsylvania PA 8,640 Dual-Eligible

H3959 AETNA HEALTH INC. (PA) Local CCP 035 0 Advantra Cares (HMO SNP)

HMO Southeastern Pennsylvania PA 819 Dual-Eligible

H3959 AETNA HEALTH INC. (PA) Local CCP 036 0 Advantra Cares (HMO SNP)

HMO Central and Western Pennsylvania PA 1,646 Dual-Eligible

H4003 MMM HEALTHCARE, LLC Local CCP 017 0 MMM Diamante Platino (HMO SNP)


H4003 MMM HEALTHCARE, LLC Local CCP 041 0 MMM Completo Platino (HMO SNP)


H4003 MMM HEALTHCARE, LLC Local CCP 047 0 MMM Valor Platino (HMO SNP)


H4004 MMM HEALTHCARE, LLC Local CCP 048 0 PMC Premier Platino (HMO SNP)

HMO PUERTO RICO PR 14,320 Dual-Eligible PBP A Platino YN

H4004 MMM HEALTHCARE, LLC Local CCP 061 0 MMM Relax Platino (HMO SNP)


H4007 HUMANA HEALTH PLANS OF PUERTO RICO, INC.


HMO Puerto Rico Island Wide PR 11,006 Dual-Eligible PBP A Platino YN



HMO Puerto Rico Island Wide PR 12,540 Dual-Eligible PBP A Platino YN



HMO Puerto Rico Island Wide PR 691 Dual-Eligible PBP A Platino YN

H4091 SIMPRA ADVANTAGE, INC. Local CCP 002 0 Simpra Advantage (PPO SNP)

Local PPO Alabama statewide AL Dual-Eligible

H4094 OPTIMUM CHOICE, INC. Local CCP 001 0 UnitedHealthcare Dual Complete (HMO SNP)

HMO Montgomery County MD 189 Dual-Eligible

H4140 DOCTORS HEALTHCARE PLANS, INC. Local CCP 002 0 DrPlus (HMO-POS SNP)

HMOPOS Miami-Dade County FL 281 Dual-Eligible

H4141 HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.


HMO Greater Georgia Area GA 7,754 Dual-Eligible

H4227 VISTA HEALTH PLAN, INC. Local CCP 001 0 Keystone First VIP Choice (HMO SNP)

HMO Eastern Pennsylvania PA 6,358 Dual-Eligible

H4227 VISTA HEALTH PLAN, INC. Local CCP 002 0 AmeriHealth Caritas VIP Care (HMO SNP)

HMO Lehigh Capital and Southwestern Pennsylvania

PA 452 Dual-Eligible

H4279 UPMC FOR YOU, INC Local CCP 001 0 UPMC for Life Dual (HMO SNP)

HMO Pennsylvania PA 28,745 Dual-Eligible





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH4346 HMO COLORADO, INC. Local CCP 014 0 Anthem MediBlue Dual

Advantage (HMO SNP)HMO Greater Denver Area CO 642 Dual-Eligible

H4407 HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY


HMO Select Mississippi Counties MS 2,272 Dual-Eligible

H4461 CARITEN HEALTH PLAN INC. Local CCP 022 0 Humana Gold Plus SNP-DE H4461-022 (HMO SNP)

HMO Greater Tennessee TN 7,427 Dual-Eligible

H4513 HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.


HMO Select Texas Counties TX 26,313 Dual-Eligible



HMO North East Texas TX 454 Dual-Eligible



HMO Select Texas Counties TX 1,444 Dual-Eligible



HMO Middle and West Tennessee TN 7,441 Dual-Eligible


Local CCP 039 0 Cigna-HealthSpring TotalCare AR (HMO SNP)

HMO Select Arkansas Counties AR 199 Dual-Eligible


Local CCP 040 0 Cigna-HealthSpring TotalCare ETN (HMO SNP)

HMO East Tennessee TN 263 Dual-Eligible



HMO Alabama AL 17,750 Dual-Eligible

H4514 UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.


HMO Houston and Austin Metro areas TX 26,799 Dual-Eligible

H4527 PHYSICIANS HEALTH CHOICE OF TEXAS, LLC

Local CCP 003 0 UnitedHealthcare Dual Complete Focus (HMO SNP)

HMO Hays, Travis, and Williamson counties

TX 1,454 Dual-Eligible



HMO Aransas, Kleberg, Nueces, San Patricio counties




HMO El Paso County TX 351 Dual-Eligible



HMO Cameron, Hidalgo, and Willacy counties




HMO Dallas/Ft Worth Metroplex TX 17,271 Dual-Eligible



HMO San Antonio Metro area TX 11,808 Dual-Eligible



HMO Corpus Christi metro area TX 6,590 Dual-Eligible

H4868 WELLCARE OF NEW YORK, INC. Local CCP 002 0 WellCare Liberty (HMO SNP)

HMO Select Counties in NY NY 1,704 Dual-Eligible

H4868 WELLCARE OF NEW YORK, INC. Local CCP 004 0 WellCare Access (HMO SNP)






H4922 AGEWELL NEW YORK, LLC Local CCP 003 0 AgeWell New York FeelWell (HMO SNP)

HMO New York City Metro Area, Nassau, Westchester

NY 212 Dual-Eligible





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH4922 AGEWELL NEW YORK, LLC Local CCP 010 0 AgeWell New York

Advantage Plus (HMO SNP)

HMO New York City Metro Area, Nassau, Westchester

NY Dual-Eligible FIDE SNP

H4931 BANNER - UNIVERSITY CARE ADVANTAGE

Local CCP 001 0 Banner - University Care Advantage (HMO SNP)

HMO Cochise, Gila, Graham, Greenlee, La Paz

AZ 1,614 Dual-Eligible



HMO Pima County AZ 3,359 Dual-Eligible



HMO Pinal, Maricopa AZ 1,596 Dual-Eligible



HMO Santa Cruz, Yuma AZ 2,833 Dual-Eligible



HMO ALTCS: Cochise, Gila, Graham, Greenlee, La Paz

AZ 301 Dual-Eligible FIDE SNP



HMO ALTCS: Pima AZ 564 Dual-Eligible FIDE SNP



HMO ALTCS: Maricopa, Pinal AZ 1,115 Dual-Eligible FIDE SNP



HMO ALTCS: Santa Cruz, Yuma AZ 559 Dual-Eligible FIDE SNP



HMO Select Counties in Washington WA 31,323 Dual-Eligible


Local CCP 009 0 UnitedHealthcare Dual Complete (HMO-POS SNP)

HMOPOS Select counties in New Mexico NM 4,726 Dual-Eligible



HMO New Orleans Metro area LA 5,210 Dual-Eligible



HMO Select Counties in Mississippi MS 2,962 Dual-Eligible



HMO Gila County AZ 126 Dual-Eligible

H5087 EASY CHOICE HEALTH PLAN INC. Local CCP 001 0 Easy Choice Freedom Plan (HMO SNP)

HMO Los Angeles County CA 5,157 Dual-Eligible

H5190 SUNSHINE STATE HEALTH PLAN, INC. Local CCP 001 0 Allwell Dual Medicare (HMO SNP)

HMO 9 Counties in Central and North Florida



HMO 9 Counties in Central and North Florida



HMO Broward County FL 179 Dual-Eligible



H5209 CARE WISCONSIN HEALTH PLAN, INC. Local CCP 002 0 Care Wisconsin Partnership Plan (HMO SNP)

HMO Southcentral and Eastern Wisconsin

WI 1,587 Dual-Eligible FIDE SNP





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH5209 CARE WISCONSIN HEALTH PLAN, INC. Local CCP 004 0 Care Wisconsin

Medicare Dual Advantage Plan (HMO SNP)

HMO Southern, Central and Northeastern Wisconsin

WI 475 Dual-Eligible

H5211 SECURITY HEALTH PLAN OF WISCONSIN, INC.

Local CCP 010 0 Ally Rx (HMO SNP) HMO Central Wisconsin WI 455 Dual-Eligible

H5215 NETWORK HEALTH INSURANCE CORPORATION

Local CCP 007 0 NetworkCares (PPO SNP)

Local PPO East Central Wisconsin WI 2,648 Dual-Eligible

H5216 HUMANA INSURANCE COMPANY Local CCP 164 0 HumanaChoice SNP-DE H5216-164 (PPO SNP)

Local PPO Select counties in Missouri MO 442 Dual-Eligible

H5253 UNITEDHEALTHCARE OF WISCONSIN, INC.

Local CCP 024 0 UnitedHealthcare Dual Complete LP (HMO SNP)

HMO Select counties in Wisconsin WI 9,656 Dual-Eligible



HMO Select Counties in North Carolina NC 21,636 Dual-Eligible



HMO Select Counties in Ohio OH 15,931 Dual-Eligible

H5294 SUPERIOR HEALTH PLAN, INC. Local CCP 002 4 Allwell Dual Medicare (HMO SNP)

HMO BX, CAM, COL, DL, EP, FB, GU, HG, NU, RW, SM, TR










TX 71 Dual-Eligible


HMO El Paso TX Dual-Eligible


HMO Suburban Houston TX Dual-Eligible


HMO North Austin TX Dual-Eligible

H5302 AETNA HEALTH INC. (GA) Local CCP 012 0 Aetna Medicare Dual Preferred (HMO SNP)

HMO Atlanta Metro GA 33 Dual-Eligible

H5322 CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.





HMO Cameron, Hidalgo, and Willacy Counties




HMOPOS Select Counties in Ohio OH 7,903 Dual-Eligible



HMOPOS Select Counties in Kansas KS 3,459 Dual-Eligible



HMOPOS Select Counties in Georgia GA 3,286 Dual-Eligible



HMO Select Counites in OK OK 3,827 Dual-Eligible

H5325 COVENTRY HEALTH CARE OF KANSAS, INC.

Local CCP 001 0 Medicare Dual Preferred Plus (HMO SNP)

HMO Johnson KS Dual-Eligible





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH5325 COVENTRY HEALTH CARE OF

KANSAS, INC.Local CCP 002 0 Medicare Dual

Preferred Plus (HMO SNP)

HMO Sedgwick KS 45 Dual-Eligible


Local CCP 003 0 Medicare Dual Core (HMO SNP)

HMO Cass Jackson MO 12 Dual-Eligible


Local CCP 004 0 Medicare Dual Core (HMO SNP)

HMO Christian Greene MO Dual-Eligible


Local CCP 005 0 Gold Dual Core (HMO SNP)

HMO Missouri MO 83 Dual-Eligible

H5337 AETNA BETTER HEALTH, INC. (OH) Local CCP 001 0 Aetna Better Health of Ohio Dual Preferred (HMO SNP)

HMO NE/NW Ohio OH Dual-Eligible

H5410 HEALTHSPRING OF FLORIDA Local CCP 013 0 Cigna-HealthSpring TotalCare (HMO SNP)

HMO Northern Florida FL 1,120 Dual-Eligible

H5410 HEALTHSPRING OF FLORIDA Local CCP 025 0 Cigna-HealthSpring TotalCare (HMO SNP)

HMO Orlando FL 58 Dual-Eligible

H5420 MEDICA HEALTHCARE PLANS, INC. Local CCP 006 0 Medica HealthCare Plans MedicareMax Plus (HMO SNP)

HMO Miami-Dade and Broward County FL 10,706 Dual-Eligible

H5422 BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA

Local CCP 007 0 Anthem MediBlue Dual Advantage (HMO SNP)

HMO Select Counties in Georgia GA 1,907 Dual-Eligible

H5425 SCAN HEALTH PLAN Local CCP 010 0 SCAN Connections (HMO SNP)

HMO Los Angeles, Riverside and San Bernardino Counties

CA 11,620 Dual-Eligible FIDE SNP

H5425 SCAN HEALTH PLAN Local CCP 029 0 SCAN Connections at Home (HMO SNP)

HMO Los Angeles County CA 1,585 Dual-Eligible FIDE SNP


HMO Riverside County CA 547 Dual-Eligible FIDE SNP


HMO San Bernardino County CA 335 Dual-Eligible FIDE SNP

H5427 FREEDOM HEALTH, INC. Local CCP 078 0 Freedom Medi-Medi Partial (HMO SNP)

HMO Select Counties in Florida FL 8,904 Dual-Eligible

H5427 FREEDOM HEALTH, INC. Local CCP 087 0 Freedom Medi-Medi Full (HMO SNP)


H5430 ONECARE BY CARE1ST HEALTH PLAN ARIZONA INC.


HMO Select Counties in Arizona AZ 1,914 Dual-Eligible

H5433 ORANGE COUNTY HEALTH AUTHORITY

Local CCP 001 0 OneCare (HMO SNP) HMO Orange County, California CA 1,426 Dual-Eligible

H5471 SIMPLY HEALTHCARE PLANS, INC. Local CCP 064 0 Simply Complete (HMO SNP)

HMO Miami-Dade FL 21,152 Dual-Eligible


HMO Polk FL 5,957 Dual-Eligible


HMO Orange, Osceola, Seminole FL 1,063 Dual-Eligible


HMO Broward FL 673 Dual-Eligible





HMO Palm Beach FL 258 Dual-Eligible

H5471 SIMPLY HEALTHCARE PLANS, INC. Local CCP 086 0 Simply Advantage (HMO SNP)

HMO Orange, Osceola, Seminole FL 656 Dual-Eligible


HMO Broward FL 294 Dual-Eligible





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH5471 SIMPLY HEALTHCARE PLANS, INC. Local CCP 088 0 Simply Advantage

(HMO SNP)HMO Hernando, Hillsborough, Pasco,

PinellasFL 697 Dual-Eligible


HMO Palm Beach FL 267 Dual-Eligible

H5475 MERIDIAN HEALTH PLAN OF MICHIGAN, INC.

Local CCP 001 0 MeridianCare Extra (HMO SNP)

HMO Genesee, Macomb, Saginaw, Oakland & Wayne Counties

MI 5,379 Dual-Eligible



HMO Barry, Kalamazoo, Kent, Muskegon, Ottawa Counties




HMO Livingston, Monroe, Washtenaw Counties

MI 427 Dual-Eligible



HMO Fulton, Henry, Lucas and Wood Counties

OH 72 Dual-Eligible



HMO Clermont and Hamilton Counties OH 13 Dual-Eligible



HMO Butler, Montgomery, Preble and Warren Counties

OH Dual-Eligible



HMO Cuyahoga, Geauga, Lake, Lorain, Medina and Summit

OH Dual-Eligible


Local CCP 023 0 MeridianCare Extra Smile (HMO SNP)

HMO Greater Detroit MI 104 Dual-Eligible


Local CCP 027 0 MeridianCare Extra Smile (HMO SNP)

HMO Clermont and Hamilton Counties OH Dual-Eligible

H5525 HUMANA BENEFIT PLAN OF ILLINOIS, INC.

Local CCP 036 0 HumanaChoice SNP-DE H5525-036 (PPO SNP)

Local PPO Greater North Carolina Area NC 1,397 Dual-Eligible

H5549 VNS CHOICE Local CCP 003 0 VNSNY CHOICE Total (HMO SNP)

HMO New York Metro Area NY 1,788 Dual-Eligible FIDE SNP

H5576 VANTAGE HEALTH PLAN, INC. Local CCP 019 0 AAA7 Vantage Dual Special Needs Plan (HMO-POS SNP)

HMOPOS State of Louisiana LA 121 Dual-Eligible

H5577 MCS ADVANTAGE, INC. Local CCP 002 0 MCS Classicare Platino Ideal (HMO SNP)


H5577 MCS ADVANTAGE, INC. Local CCP 017 0 MCS Classicare Platino Progreso (HMO SNP)


H5577 MCS ADVANTAGE, INC. Local CCP 027 0 MCS Classicare Platino C≤modo (HMO SNP)


H5577 MCS ADVANTAGE, INC. Local CCP 028 0 MCS Classicare Platino Clßsico (HMO SNP)


H5577 MCS ADVANTAGE, INC. Local CCP 029 0 MCS Classicare Platino MßsCa$h (HMO SNP)


H5577 MCS ADVANTAGE, INC. Local CCP 036 0 MCS Classicare Platino OTC (HMO SNP)


H5580 MERCY CARE Local CCP 001 0 Mercy Care Advantage (HMO SNP)

HMO Maricopa, Pinal, and Gila Counties AZ 10,427 Dual-Eligible

H5580 MERCY CARE Local CCP 004 0 Mercy Care Advantage (HMO SNP)

HMO Maricopa, Gila, Pinal, and Pima Counties

AZ 5,138 Dual-Eligible FIDE SNP





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH5580 MERCY CARE Local CCP 005 0 Mercy Care Advantage

(HMO SNP)HMO Maricopa, Pima and Santa Cruz

CountiesAZ 1,271 Dual-Eligible

H5587 HEALTH CHOICE ARIZONA, INC. Local CCP 002 0 Steward Health Choice Generations (HMO SNP)

HMO Counties: APA, CCN, GIL, MAR, MOH, NAV, PIN, YAV

AZ 8,533 Dual-Eligible

H5590 BRIDGEWAY HEALTH SOLUTIONS Local CCP 006 2 Allwell Dual Medicare (HMO SNP)

HMO Central and Southern AZ Counties AZ 1,158 Dual-Eligible

H5590 BRIDGEWAY HEALTH SOLUTIONS Local CCP 006 1 Allwell Dual Medicare (HMO SNP)

HMO Central and Southern AZ Counties AZ 1,491 Dual-Eligible

H5594 OPTIMUM HEALTHCARE, INC. Local CCP 016 0 Optimum Emerald Partial (HMO SNP)


H5594 OPTIMUM HEALTHCARE, INC. Local CCP 017 0 Optimum Emerald Full (HMO SNP)


H5608 DENVER HEALTH MEDICAL PLAN, INC. Local CCP 001 0 Denver Health Medicare Choice (HMO SNP)

HMO Denver County CO 1,561 Dual-Eligible

H5619 ARCADIAN HEALTH PLAN, INC. Local CCP 003 0 Humana Gold Plus SNP-DE H5619-003 (HMO SNP)

HMO Select Counties in Maine ME 2,229 Dual-Eligible


HMO Select Counties in California CA 5,041 Dual-Eligible


HMO Select counties in Indiana IN 6,671 Dual-Eligible


HMO Select counties in Washington WA 1,748 Dual-Eligible


HMO Central Kentucky Area KY 1,284 Dual-Eligible


HMO Clark and Floyd counties IN 203 Dual-Eligible


HMO Greater South Carolina SC 4,188 Dual-Eligible


HMO Greater Alabama AL 5,824 Dual-Eligible

H5628 MOLINA HEALTHCARE OF UTAH, INC. Local CCP 001 0 Molina Medicare Options Plus (HMO SNP)

HMO Salt Lake City UT 5,116 Dual-Eligible

H5628 MOLINA HEALTHCARE OF UTAH, INC. Local CCP 006 0 Healthy Advantage (HMO SNP)

HMO Salt Lake City UT 2,058 Dual-Eligible

H5628 MOLINA HEALTHCARE OF UTAH, INC. Local CCP 008 0 Molina Medicare Options Plus (HMO SNP)

HMO Idaho ID 741 Dual-Eligible FIDE SNP


Local CCP 002 0 Central Health Medi-Medi Plan (HMO SNP)

HMO Counties: LA and SB CA 4,112 Dual-Eligible


Local CCP 009 0 Central Health Ventura Medi-Medi Plan (HMO SNP)

HMO Ventura County CA 515 Dual-Eligible





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH5649 CENTRAL HEALTH PLAN OF

CALIFORNIA, INC.Local CCP 014 0 Central Health Elite

HMO SNP (HMO SNP)HMO Counties: San Benito and San

JoaquinCA Dual-Eligible

H5703 SOUTH COUNTRY HEALTH ALLIANCE Local CCP 001 0 AbilityCare (HMO SNP) HMO Select Counties in Minnesota MN 591 Dual-Eligible

H5742 SHA, LLC Local CCP 001 0 FirstCare Advantage Dual SNP (HMO SNP)

HMO FirstCare Advantage Dual SNP TX Dual-Eligible

H5774 TRIPLE S ADVANTAGE, INC. Local CCP 024 0 Platino Plus (HMO SNP)


H5774 TRIPLE S ADVANTAGE, INC. Local CCP 025 0 Platino Ultra (HMO SNP)


H5774 TRIPLE S ADVANTAGE, INC. Local CCP 026 0 Platino Advance (HMO SNP)


H5774 TRIPLE S ADVANTAGE, INC. Local CCP 028 0 Platino Blindao (HMO SNP)


H5810 MOLINA HEALTHCARE OF CALIFORNIA


HMO Southern California CA 2,007 Dual-Eligible

H5823 MOLINA HEALTHCARE OF WASHINGTON, INC.


HMO Seattle, Tacoma, Spokane WA 9,584 Dual-Eligible

H5826 COMMUNITY HEALTH PLAN OF WASHINGTON

Local CCP 014 0 Community HealthFirst MA Special Needs Plan (HMO SNP)

HMO Eastern and Western Washington State

WA 4,262 Dual-Eligible

H5854 ANTHEM HEALTH PLANS, INC. Local CCP 008 0 Anthem MediBlue Dual Advantage (HMO SNP)

HMO Select Counties in Connecticut CT 17,185 Dual-Eligible

H5859 HEALTH PLAN OF CAREOREGON, INC. Local CCP 001 0 CareOregon Advantage Plus (HMO-POS SNP)

HMOPOS Portland Metro Area, Jackson, Tillamook, Columbia

OR 11,313 Dual-Eligible

H5926 MOLINA HEALTHCARE OF MICHIGAN, INC.


HMO Grand Rapids, Flint, Saginaw, Detroit


H5928 CARE1ST HEALTH PLAN Local CCP 001 0 Blue Shield Promise TotalDual Plan (HMO SNP)

HMO Los Angeles County CA 437 Dual-Eligible


HMO Orange and San Bernardino Counties

CA 194 Dual-Eligible


HMO San Diego County CA 239 Dual-Eligible

H5932 GATEWAY HEALTH PLAN, INC. Local CCP 001 0 Gateway Health Medicare Assured Diamond (HMO SNP)

HMO Pennsylvania Counties PA 41,308 Dual-Eligible

H5932 GATEWAY HEALTH PLAN, INC. Local CCP 009 0 Gateway Health Medicare Assured Ruby (HMO SNP)

HMO Pennsylvania Counties PA 6,208 Dual-Eligible

H5937 UCARE MINNESOTA Local CCP 001 0 UCare Connect + Medicare (HMO SNP)

HMO Twin Cities Metro Area, Rochester, St. Cloud

MN 2,439 Dual-Eligible

H5969 ALOHACARE Local CCP 002 0 AlohaCare Advantage Plus (HMO SNP)

HMO State of Hawaii HI 1,806 Dual-Eligible





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH5970 HUMANA INSURANCE COMPANY OF

NEW YORKLocal CCP 020 0 HumanaChoice SNP-

DE H5970-020 (PPO SNP)

Local PPO Cattaraugus, Chautauqua and Madison counties



Local CCP 001 0 EmblemHealth Affinity Medicare Ultimate (HMO SNP)

HMO NYC, Nassau ,Orange, Rockland, Suffolk,Westchester



Local CCP 002 0 EmblemHealth Affinity Medicare Solutions (HMO SNP)

HMO NYC, Nassau ,Orange, Rockland, Suffolk,Westchester


H5992 SENIOR WHOLE HEALTH OF NEW YORK, INC.

Local CCP 007 0 Senior Whole Health of New York NHC (HMO SNP)

HMO Counties: Ki, Qu, Brx, NY, Wes, and Na

NY 86 Dual-Eligible FIDE SNP

H5995 ATRIO HEALTH PLANS Local CCP 001 0 ATRIO Special Needs Plan (Willamette) (HMO SNP)

HMO Marion and Polk Counties OR 3,295 Dual-Eligible

H6550 SUNFLOWER STATE HEALTH PLAN, INC.


HMO Counties CK, CR, JO, LV, MI, SG, WY

KS 237 Dual-Eligible

H6595 UNITEDHEALTHCARE OF KENTUCKY, LTD.


HMO Select Counties in Kentucky KY 229 Dual-Eligible



HMO Select Counties in Montana MT 722 Dual-Eligible



HMO Select counties in Ohio OH 3,049 Dual-Eligible



HMO Northern Kentucky Area KY 453 Dual-Eligible


Local CCP 024 0 Humana Cleveland Clinic Preferred SNP-DE (HMO SNP)

HMO Cuyahoga County OH 341 Dual-Eligible



HMO Western North Carolina Area NC 643 Dual-Eligible



HMO Select counties in Pennsylvania PA 2,464 Dual-Eligible



HMO Hattiesburg MS 693 Dual-Eligible



HMO Kent, New Castle and Sussex Counties

DE 206 Dual-Eligible

H6672 EON HEALTH, INC. (GA) Local CCP 001 0 EON DELUXE (HMO SNP)

HMO Select Georgia Counties GA 139 Dual-Eligible

H6776 ELDERSERVE HEALTH, INC. Local CCP 002 0 RiverSpring MAP (HMO SNP)

HMO Counties: Brx, Ki, Na, NY, Qu, Ri, Wes

NY Dual-Eligible

H6988 CENTERS PLAN FOR HEALTHY LIVING, LLC

Local CCP 002 0 Centers Plan for Dual Coverage Care (HMO SNP)

HMO Kings,Queens,Bronx,Manhattan and Richmond Counties



Local CCP 004 0 Centers Plan for Medicaid Advantage Plus (HMO SNP)

HMO NYC Metro Area, NASS, ROCK County

NY Dual-Eligible FIDE SNP





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH7173 PEACH STATE HEALTH PLAN, INC. Local CCP 001 0 Allwell Dual Medicare

(HMO SNP)HMO Metro Atl, N. GA, Muscogee, Chatt,

Harris, HeardGA 669 Dual-Eligible

H7464 UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.


HMO Select Counties in VA VA 2,238 Dual-Eligible

H7678 MOLINA HEALTHCARE OF TEXAS, INC. Local CCP 001 0 Molina Medicare Options Plus (HMO SNP)

HMO Texas TX 1,461 Dual-Eligible

H8130 MOLINA HEALTHCARE OF FLORIDA, INC.


HMO Tampa, West Palm Beach, Miami FL 2,296 Dual-Eligible

H8133 GHS INSURANCE COMPANY Local CCP 009 0 Blue Cross Medicare Advantage Dual Care (HMO SNP)

HMO Bastrp,Burnet,Caldwl,Hays,Lee,&Wilmson ctys

TX Dual-Eligible

H8189 MANAGED HEALTH SERVICES, WISCONSIN


HMO Southeastern, Northeastern, Central Counties

WI 1,186 Dual-Eligible

H8298 HORIZON HEALTHCARE OF NEW JERSEY, INC.

Local CCP 001 0 Horizon NJ TotalCare (HMO SNP)

HMO New Jersey NJ 8,218 Dual-Eligible FIDE SNP

H8432 EMPIRE HEALTHCHOICE HMO, INC. Local CCP 002 0 Anthem MediBlue Dual Advantage (HMO SNP)

HMO Select Counties in Maine ME 3,665 Dual-Eligible

H8432 EMPIRE HEALTHCHOICE HMO, INC. Local CCP 007 0 Empire MediBlue Dual Advantage (HMO SNP)

HMO New York City Area NY 10,079 Dual-Eligible

H8432 EMPIRE HEALTHCHOICE HMO, INC. Local CCP 018 0 Empire MediBlue Dual Advantage (HMO SNP)

HMO Albany, Rensselaer, Schenectady, Dutchess, Putnam


H8432 EMPIRE HEALTHCHOICE HMO, INC. Local CCP 028 0 Empire MediBlue Dual Advantage Select (HMO SNP)

HMO Select Counties in NY NY 555 Dual-Eligible

H8597 AETNA BETTER HEALTH OF TEXAS INC.

Local CCP 001 0 Aetna Medicare Dual Core (HMO SNP)

HMO Bexar and Guadalupe counties TX Dual-Eligible

H8597 AETNA BETTER HEALTH OF TEXAS INC.

Local CCP 002 0 Aetna Medicare Dual Core (HMO SNP)

HMO Johnson and Tarrant counties TX Dual-Eligible

H8854 UNIVERSITY OF MARYLAND HEALTH ADVANTAGE, INC.

Local CCP 002 0 UMHA Dual (HMO SNP)

HMO Select Maryland Counties MD 4,391 Dual-Eligible

H8908 HUMANA MEDICAL PLAN OF MICHIGAN, INC.


HMO Select counties in Michigan MI 69 Dual-Eligible

H9001 FALLON COMMUNITY HEALTH PLAN Local CCP 019 0 NaviCare (HMO SNP) HMO Massachusetts except Dukes and Nantucket counties


H9047 PROVIDENCE HEALTH ASSURANCE Local CCP 043 0 Providence Medicare Dual Plus (HMO SNP)

HMO Portland Metro OR 935 Dual-Eligible

H9066 VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK

Local CCP 001 0 Nascentia Health Plus (HMO SNP)

HMO Upstate New York NY Dual-Eligible


Local CCP 003 0 Nascentia Health Dual (HMO SNP)

HMO Upstate New York NY Dual-Eligible

H9082 MOLINA HEALTHCARE OF NEW MEXICO, INC.


HMO Albuquerque, Santa Fe NM 3,636 Dual-Eligible

H9190 GATEWAY HEALTH PLAN OF OHIO, INC.

Local CCP 001 0 Gateway Health Medicare Assured Diamond (HMO SNP)

HMO Ohio Counties OH 800 Dual-Eligible





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH9190 GATEWAY HEALTH PLAN OF OHIO,

INC.Local CCP 002 0 Gateway Health

Medicare Assured Ruby (HMO SNP)

HMO Ohio Counties OH 184 Dual-Eligible


Local CCP 007 0 Gateway Health Medicare Assured Diamond (HMO SNP)

HMO North Carolina Counties NC 1,091 Dual-Eligible


Local CCP 008 0 Gateway Health Medicare Assured Ruby (HMO SNP)

HMO North Carolina Counties NC 315 Dual-Eligible

H9207 HEALTH PARTNERS PLANS, INC. Local CCP 004 0 Health Partners Medicare Special (HMO SNP)

HMO Bucks, Chester, Del, Lan, Leh, Nrtha, Phila

PA 11,651 Dual-Eligible

H9364 WELLCARE OF MAINE, INC. Local CCP 002 0 WellCare Access (HMO SNP)

HMO Selected Counties in ME ME 768 Dual-Eligible

H9403 EON HEALTH, INC. (SC) Local CCP 001 0 EON DELUXE (HMO SNP)

HMO Select South Carolina Counties SC 46 Dual-Eligible

H9455 HEALTH CHOICE UTAH, INC. Local CCP 001 0 Steward Health Choice Generations (HMO SNP)

HMO Salt Lake, Utah, Davis, Weber, Tooele

UT 26 Dual-Eligible

H9525 COMPCARE HEALTH SERVICES INSURANCE CORPORATION


HMO Select Counties in Wisconsin WI 1,087 Dual-Eligible

H9525 COMPCARE HEALTH SERVICES INSURANCE CORPORATION


HMO Select Counties in Kentucky KY 4,374 Dual-Eligible

H9585 BOSTON MEDICAL CENTER HEALTH PLAN, INC.

Local CCP 001 0 BMC HealthNet Plan Senior Care Options (HMO SNP)

HMO Barnstable, Bristol, Hampden, Plymouth, Suffolk

MA 948 Dual-Eligible FIDE SNP

H9725 CIGNA HEALTHCARE OF NORTH CAROLINA, INC.

Local CCP 003 0 Cigna-HealthSpring TotalCare Direct (HMO SNP)

HMO Select North Carolina Counties NC 740 Dual-Eligible

H9730 WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC

Local CCP 003 0 WellCare Access (HMO SNP)

HMO Select Counties in KY KY 4,077 Dual-Eligible

H9730 WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC


HMO Select KY Counties KY 1,948 Dual-Eligible

H9811 MAGNOLIA HEALTH PLAN, INC. Local CCP 006 0 Allwell Dual Medicare (HMO SNP)

HMO George, Harr, Hinds, Jackson, Mad, Rankin, Stone

MS 17 Dual-Eligible

H9870 UNIVERSITY HEALTH CARE, INC. Local CCP 001 0 Passport Advantage (HMO SNP)

HMO Jefferson and fifteen surrounding counties

KY 2,745 Dual-Eligible

H9877 VIRGINIA PREMIER HEALTH PLAN, INC.

Local CCP 001 0 Virginia Premier Advantage Elite (HMO SNP)

HMO Central, Tidewater, Western, Roanoke, NOVA

VA 3,279 Dual-Eligible

H9952 MEDICA HEALTH PLANS Local CCP 001 0 Medica AccessAbility Solution Enhanced (HMO SNP)

HMO Minneapolis/St. Paul Metro Area MN Dual-Eligible

R1548 UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY

Regional CCP 001 0 UnitedHealthcare Dual Complete RP (Regional PPO SNP)

Regional PPO North Carolina and Virginia NC; VA 30,197 Dual-Eligible



Regional PPO State of Hawaii HI 4,286 Dual-Eligible


Regional CCP 011 0 UnitedHealthcare Dual Complete Choice (Regional PPO SNP)

Regional PPO Arkansas and Missouri AR; MO 27,963 Dual-Eligible





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesR6801 CARE IMPROVEMENT PLUS OF TEXAS

INSURANCE COMPANYRegional CCP 011 0 UnitedHealthcare Dual

Complete Choice (Regional PPO SNP)

Regional PPO Texas TX 23,800 Dual-Eligible


Regional CCP 011 0 UnitedHealthcare Dual Complete Choice (Regional PPO SNP)

Regional PPO Georgia and South Carolina GA; SC 54,266 Dual-Eligible



Regional PPO State of Florida FL 63,863 Dual-Eligible


Regional CCP 013 0 UnitedHealthcare Dual Complete RP ONE (Regional PPO SNP)

Regional PPO State of Florida FL 392 Dual-Eligible FIDE SNP

Under-11 81 Dual-EligibleH0544 BLUE CROSS OF CALIFORNIA Local CCP 005 0 Anthem Care On Site

(HMO SNP)HMO Los Angeles and Orange Counties CA 2,499 Institutional

H0544 BLUE CROSS OF CALIFORNIA Local CCP 050 0 Anthem Care On Site (HMO SNP)

HMO Santa Clara County CA 310 Institutional


Local CCP 004 0 UnitedHealthcare Nursing Home Plan (PPO SNP)

Local PPO Select Counties in Alabama and Florida

AL; FL 990 Institutional



Local PPO Maricopa, Pima, Pinal, and Yavapai counties

AZ 1,034 Institutional



Local PPO Denver and Colorado Springs metro areas

CO 3,143 Institutional


Local CCP 008 0 UnitedHealthcare Assisted Living Plan (PPO SNP)

Local PPO Denver and Colorado Springs metro areas

CO 184 Institutional



Local PPO Fairfield, Hartford, and New Haven counties

CT Institutional



Local PPO Select Counties in Florida FL 4,633 Institutional



Local PPO Select Counties in Florida FL Institutional



Local PPO Select Counties in Indiana IN 1,731 Institutional



Local PPO Select Counties in Maine and New Hampshire

ME; NH 438 Institutional



Local PPO St. Louis and Springfield Metro areas

IL; MO 565 Institutional


Local CCP 017 0 UnitedHealthcare Nursing Home Plan 2 (PPO SNP)

Local PPO Select Counties in Pennsylvania, State of Delaware

DE; PA 5,280 Institutional



Local PPO Select counties in Texas TX 783 Institutional





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH0710 UNITEDHEALTHCARE INSURANCE

COMPANYLocal CCP 026 0 UnitedHealthcare

Nursing Home Plan (PPO SNP)

Local PPO Connecticut and Select counties in New Jersey

CT; NJ 6,603 Institutional



Local PPO Select Counties in Ohio OH 254 Institutional



Local PPO Select counties in Washington WA 31 Institutional



Local PPO Select counties in Washington WA 1,983 Institutional



Local PPO Select Counties in Maryland and Virginia

MD; VA 664 Institutional



Local PPO Select Counties in Georgia GA 828 Institutional



Local PPO Select Counties in North Carolina NC 93 Institutional



Local PPO State of Rhode Island RI 28 Institutional



Local PPO Select Counties in Oregon OR 142 Institutional


Local CCP 037 0 UnitedHealthcare Assisted Living Plan 2 (PPO SNP)




Local PPO Hillsborough County FL 376 Institutional



Local PPO Chicago Metro area IL Institutional



Local PPO Boston, Springfield, and Worcester Metro Areas

MA Institutional



Local PPO Select Counties in Twin Cities Metro Area

MN Institutional



Local PPO Select Counties in Wisconsin WI Institutional



Local PPO Select Counties in Wisconsin WI Institutional

H0838 UNIVERSAL CARE, INC. Local CCP 041 0 Brand New Day Select Care Plan (HMO SNP)


CA Institutional

H1119 TSG GUARD, INC. Local CCP 001 0 Valor Health Plan (HMO SNP)

HMO Northeast and Central Ohio OH 79 Institutional





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH1372 MARQUIS ADVANTAGE, INC. Local CCP 001 0 AgeRight Advantage

Health Plan (HMO SNP)

HMO OR Counties: CLK, KLA, LAN, MUL, WSH & YAM

OR 456 Institutional

H1587 ARKANSAS SUPERIOR SELECT, INC. Local CCP 003 0 Select (HMO-POS SNP)

HMOPOS Arkansas AR Institutional

H1722 HEALTH POINTE OF NEW YORK, LLC Local CCP 001 0 Health Pointe Direct Complete Plan (HMO SNP)

HMO Counties: NY, KNG, QNS, BRX, NAS, WC

NY Institutional

H1777 CATHOLIC SPECIAL NEEDS PLAN, LLC Local CCP 007 0 ArchCare Advantage (HMO SNP)

HMO NYC, Westchester, Putnam, Dutchess, Orange, Ononda

NY 1,787 Institutional

H1787 GOOD SAMARITAN INSURANCE PLAN OF SOUTH DAKOTA, INC

Local CCP 001 0 Great Plains Medicare Advantage (HMO SNP)

HMO South Dakota (partial) SD 287 Institutional

H2108 BRAVO HEALTH MID-ATLANTIC, INC. Local CCP 020 0 Cigna-HealthSpring Traditions (HMO SNP)

HMO Maryland, Washington DC, and Delaware Counties

DC; DE; MD 234 Institutional

H2185 LIFEWORKS ADVANTAGE, LLC Local CCP 001 0 LifeWorks Advantage I-SNP (HMO SNP)

HMO Virginia (partial) VA 761 Institutional



Local PPO Boston, Springfield and Worcester Metro Areas

MA 85 Institutional



Local PPO State of Rhode Island RI 1,766 Institutional



Local PPO Select Counties in Delaware, Maryland and Virginia

DE; MD; VA 2,480 Institutional



Local PPO Select Counties in Maryland MD Institutional



Local PPO Select Counties in Georgia GA 2,188 Institutional





Local CCP 017 0 UnitedHealthcare Assisted Living Plan 1 (PPO SNP)




Local PPO Select Counties in Rhode Island RI Institutional

H2292 OXFORD HEALTH INSURANCE, INC. Local CCP 001 0 UnitedHealthcare Nursing Home Plan 1 (PPO SNP)

Local PPO Upstate New York NY 1,590 Institutional

H2292 OXFORD HEALTH INSURANCE, INC. Local CCP 002 0 UnitedHealthcare Nursing Home Plan 1 (PPO SNP)

Local PPO New York City NY 1,925 Institutional

H2392 KANSAS SUPERIOR SELECT, INC. Local CCP 001 0 Kansas Health Advantage (HMO SNP)

HMO Central and East Kansas KS 269 Institutional

H2400 SIGNATURE ADVANTAGE, LLC Local CCP 001 0 Signature Advantage (HMO SNP)

HMO KY (partial) KY 149 Institutional





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH2406 SIERRA HEALTH AND LIFE

INSURANCE COMPANY, INC.Local CCP 001 0 UnitedHealthcare

Nursing Home Plan 1 (PPO SNP)

Local PPO Select Counties in Ohio OH 1,959 Institutional

H2593 AMERIGROUP TEXAS, INC. Local CCP 003 0 Amerivantage CareMore Care To You (HMO SNP)

HMO Pima County AZ 1,068 Institutional

H2593 AMERIGROUP TEXAS, INC. Local CCP 019 0 Amerivantage CareMore Care To You (HMO SNP)

HMO Maricopa County AZ 598 Institutional

H2802 UNITEDHEALTHCARE OF THE MIDLANDS, INC.

Local CCP 027 0 UnitedHealthcare Nursing Home Plan 1 (HMO-POS SNP)

HMOPOS Chicago Metro area IL 849 Institutional

H3113 OXFORD HEALTH PLANS (NJ), INC. Local CCP 001 0 UnitedHealthcare Nursing Home Plan (HMO SNP)

HMO Northern and Central New Jersey NJ 191 Institutional

H3113 OXFORD HEALTH PLANS (NJ), INC. Local CCP 008 0 UnitedHealthcare Assisted Living Plan (HMO SNP)

HMO Lane County OR 167 Institutional

H3291 PRUITTHEALTH PREMIER, INC. Local CCP 001 0 PruittHealth Premier (HMO SNP)

HMO Georgia (partial) GA 1,638 Institutional

H3347 ELDERPLAN, INC. Local CCP 003 0 Elderplan Advantage For Nursing Home Residents (HMO SNP)

HMO Brx, Ki, Monr, Na, NY, Qu, Ri, Suf, Wes

NY 1,735 Institutional

H3362 INDEPENDENT HEALTH ASSOCIATION, INC.

Local CCP 020 0 Independent Health Medicare Family Choice (HMO SNP)

HMO Western New York NY 1,277 Institutional


Local CCP 002 0 UnitedHealthcare Nursing Home Plan 2 (HMO SNP)

HMO New York City NY 6,475 Institutional



HMO Upstate New York NY 3,106 Institutional



HMO Jefferson County NY 115 Institutional

H3447 HEALTHKEEPERS, INC. Local CCP 010 0 Anthem MediBlue Care On Site (HMO SNP)


VA 212 Institutional

H3708 OKLAHOMA SUPERIOR SELECT, INC. Local CCP 001 0 American Health Advantage of Oklahoma (HMO SNP)

HMO Central and East Oklahoma OK 249 Institutional

H3930 SPARTAN PLAN NY, INC. Local CCP 001 0 Sunrise Advantage Plan I-SNP (HMO SNP)

HMO New York (partial) NY 53 Institutional

H3930 SPARTAN PLAN NY, INC. Local CCP 004 0 Sunrise Advantage Plan Gold (HMO SNP)

HMO New York (partial) NY Institutional

H3949 BRAVO HEALTH PENNSYLVANIA, INC. Local CCP 016 0 Cigna-HealthSpring Traditions (HMO SNP)

HMO Select Pennsylvania Counties PA 235 Institutional


Local CCP 020 0 BlueJourney Alliance Assisted Care (HMO SNP)

HMO 6 Counties in Central PA PA Institutional

H4091 SIMPRA ADVANTAGE, INC. Local CCP 001 0 Simpra Advantage (PPO SNP)

Local PPO Alabama statewide AL 2,326 Institutional





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH4093 PROVIDER PARTNERS HEALTH PLAN

OF PENNSYLVANIA, INCLocal CCP 001 0 Provider Partners

Pennsylvania Advantage Plan (HMO SNP)

HMO PA East & West Borders PA 633 Institutional

H4172 NHC ADVANTAGE, LLC Local CCP 001 0 NHC Advantage (HMO SNP)

HMO Missouri (partial) Tennessee (partial)

MO; TN 1,057 Institutional

H4172 NHC ADVANTAGE, LLC Local CCP 002 0 NHC Advantage Gold (HMO SNP)

HMO Missouri (partial) Tennessee (partial)

MO; TN 19 Institutional

H4236 SPARTAN PLAN PA, INC. Local CCP 001 0 Sunrise Advantage Plan I-SNP (HMO SNP)

HMO Pennsylvania (partial) PA 79 Institutional

H4236 SPARTAN PLAN PA, INC. Local CCP 004 0 Sunrise Advantage Plan Gold (HMO SNP)

HMO Pennsylvania (partial) PA Institutional

H4346 HMO COLORADO, INC. Local CCP 010 0 Anthem Care On Site (HMO SNP)

HMO Clark County NV 690 Institutional

H4490 MISSOURI MEDICARE SELECT, LLC Local CCP 001 0 Missouri Medicare Select (HMO SNP)

HMO MO Counties: CAS, JAK, LAF, SCH & STL

MO Institutional

H4778 SPARTAN PLAN IL, INC. Local CCP 001 0 Sunrise Advantage Plan I-SNP (HMO SNP)

HMO Illinois (partial) IL 57 Institutional

H4778 SPARTAN PLAN IL, INC. Local CCP 004 0 Sunrise Advantage Plan Gold (HMO SNP)

HMO Illinois (partial) IL Institutional

H4922 AGEWELL NEW YORK, LLC Local CCP 004 0 AgeWell New York CareWell (HMO SNP)

HMO New York City Metro Area, Long Island, Westchester

NY 502 Institutional


Local CCP 001 0 UnitedHealthcare Nursing Home Plan (HMO SNP)

HMO King, Kitsap, Pierce, and Snohomish Counties

WA 137 Institutional


Local CCP 007 0 UnitedHealthcare Nursing Home Plan 1 (HMO-POS SNP)

HMOPOS Select Counties in Wisconsin WI 1,964 Institutional



HMO Select Counties in North Carolina NC 3,142 Institutional


Local CCP 043 0 UnitedHealthcare Assisted Living Plan (HMO-POS SNP)

HMOPOS Select Counties in North Carolina NC Institutional


Local CCP 060 0 UnitedHealthcare Nursing Home Plan (HMO-POS SNP)

HMOPOS Select Counties in Ohio OH 441 Institutional



HMOPOS Lake, Lorain, and Lucas Counties OH Institutional



HMOPOS Select Counties in Wisconsin WI 368 Institutional



HMOPOS Select Counties in OH, SC and VA OH; SC; VA 164 Institutional



HMO Select Counties in FL and NJ FL; NJ 280 Institutional



HMOPOS Atlanta and Augusta Metro areas GA 183 Institutional





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH5471 SIMPLY HEALTHCARE PLANS, INC. Local CCP 067 0 Simply Care (HMO

SNP)HMO Miami-Dade FL 14 Institutional

H5471 SIMPLY HEALTHCARE PLANS, INC. Local CCP 068 0 Simply Comfort (HMO SNP)

HMO Miami-Dade FL 244 Institutional

H5471 SIMPLY HEALTHCARE PLANS, INC. Local CCP 079 0 Simply Care (HMO SNP)

HMO Broward FL Institutional


HMO Broward FL Institutional


HMO Polk FL Institutional


HMO Polk FL Institutional


HMO Orange, Osceola, Seminole FL Institutional


HMO Orange, Osceola, Seminole FL Institutional



FL Institutional



FL Institutional


HMO Palm Beach FL Institutional


HMO Palm Beach FL Institutional

H5652 SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.

Local CCP 003 0 Erickson Advantage Guardian (HMO-POS SNP)

HMOPOS Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA,NC

CO; KS; MA; MD; MI; NC; NJ; PA; TX; VA

169 Institutional

H5989 CENTERLIGHT HEALTHCARE, INC. Local CCP 002 0 CenterLight Healthcare Direct Complete Plan (HMO SNP)

HMO NYC, LI, Westchester and Rockland Counties


H6345 PRUITTHEALTH PREMIER NORTH CAROLINA, LLC

Local CCP 001 0 PruittHealth Premier (HMO SNP)

HMO NC (Partial) NC 166 Institutional

H6345 PRUITTHEALTH PREMIER NORTH CAROLINA, LLC

Local CCP 002 0 PruittHealth Premier (HMO SNP)

HMO South Carolina (partial) SC 251 Institutional

H6351 LIBERTY ADVANTAGE, LLC Local CCP 001 0 Liberty Advantage (HMO SNP)

HMO North Carolina (partial) NC 695 Institutional

H6351 LIBERTY ADVANTAGE, LLC Local CCP 002 0 Liberty Advantage Gold (HMO SNP)

HMO North Carolina (partial) NC Institutional

H6351 LIBERTY ADVANTAGE, LLC Local CCP 003 0 Liberty at Home (HMO SNP)

HMO North Carolina (partial) NC Institutional

H6776 ELDERSERVE HEALTH, INC. Local CCP 001 0 RiverSpring Star (HMO SNP)

HMO Counties: Brx, Ki, Na, NY, Qu, Ri, Wes



Local CCP 003 0 Centers Plan for Nursing Home Care (HMO SNP)

HMO NYC Metro Area, Rockland, Erie, Niagara Counties

NY 29 Institutional

H7119 PROVIDER PARTNERS HEALTH PLAN OF OHIO

Local CCP 001 0 Provider Partners Health Plan of Ohio (HMO SNP)

HMO Central, Southern, Northeastern OH Institutional

H7511 GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.


HMO Nebraska (partial) NE 469 Institutional





Plan Enrollment

Special Needs Plan

Type Specialty DiseasesH7511 GOOD SAMARITAN INSURANCE PLAN

OF NEBRASKA, INC.Local CCP 002 0 Great Plains Medicare

Advantage Gold (HMO SNP)

HMO Nebraska (partial) NE Institutional

H7779 AMERICAN HEALTH PLAN, INC. Local CCP 001 0 American Health Advantage of Tennessee (HMO SNP)

HMO Tennessee TN 225 Institutional

H7802 SPARTAN PLAN VA, INC. Local CCP 001 0 Sunrise Advantage Plan I-SNP (HMO SNP)

HMO Virginia (partial) VA 46 Institutional

H7802 SPARTAN PLAN VA, INC. Local CCP 004 0 Sunrise Advantage Plan Gold (HMO SNP)

HMO Virginia (partial) VA Institutional

H8067 PROVIDER PARTNERS HEALTH PLAN, INC.

Local CCP 001 0 Provider Partners Maryland Advantage Plan (HMO SNP)

HMO Western & Central Maryland MD 387 Institutional

H8067 PROVIDER PARTNERS HEALTH PLAN, INC.

Local CCP 002 0 Provider Partners Illinois Advantage Plan (HMO SNP)

HMO Cook County IL Institutional

H8457 LONGEVITY HEALTH PLAN OF NEW YORK, INC.

Local CCP 001 0 Longevity Health Plan (HMO SNP)

HMO New York (partial) NY 33 Institutional

H8967 GOOD SAMARITAN INSURANCE PLAN OF NORTH DAKOTA, LLC


HMO North Dakota (partial) ND 193 Institutional


Local CCP 002 0 Nascentia Health Institutional (HMO SNP)

HMO Upstate New York NY Institutional

H9104 SCAN HEALTH PLAN Local CCP 006 0 SCAN Healthy at Home (HMO SNP)

HMO Los Angeles, Orange, and Inland Empire Areas

CA 43 Institutional

H9153 WEST VIRGINIA SENIOR ADVANTAGE, INC.

Local CCP 001 0 WV Senior Advantage (HMO SNP)

HMO West Virginia (partial) WV 576 Institutional

H9590 LONGEVITY HEALTH PLAN OF ILLINOIS, INC.

Local CCP 001 0 Longevity Health Plan (HMO SNP)

HMO Illinois (partial) IL Institutional

Under-11 20 Institutional


Documents

Special Needs Plan Comprehensive Report - snpalliance.orgsnpalliance.org/media/1290/snp_2019_01a.pdf · Cardio DIS CHF and Diabetes H2793 IMPERIAL INSURANCE COMPANY OF TEXAS, INC