Newsroom · Sioux Falls

Chronic condition special needs plans: why Sioux Falls doesn't have Medicare's fastest-growing plan type in 2026

Nationally, enrollment in plans built around diabetes and heart disease jumped 71% in a single year. In Minnehaha County, the number available for 2026 is zero.

Big Sioux Benefits Data Desk

Published September 9, 2026 · 17 min read · Sourced from CMS.gov

If you have diabetes or heart disease and you've heard there's a Medicare Advantage plan built specifically around managing it, you're right that one exists — and if you're looking for it in Sioux Falls for 2026, you won't find it. A Chronic Condition Special Needs Plan, or C-SNP, is real, it's the fastest-growing type of Medicare Advantage plan in the country right now, and the federal government's own 2026 plan data shows exactly zero of them operating anywhere in South Dakota. That gap between the national conversation and the local shelf is exactly the kind of thing worth understanding before this fall's enrollment window, whether or not a C-SNP ever arrives here.

Every figure in this guide comes from a primary source fetched this week: CMS's own Chronic Condition Special Needs Plans page, KFF's September 2025 analysis of Medicare Advantage Special Needs Plan growth, the CMS PY2026 Medicare Advantage/Part D Landscape file for South Dakota and Minnehaha County, CDC PLACES county health data, and CMS's own Chronic Care Management page. No numbers from memory.

What a C-SNP actually is

A Chronic Condition Special Needs Plan is a type of Medicare Advantage plan that CMS allows an insurer to restrict to people with a specific, severe, or disabling chronic condition. Every C-SNP still has to cover everything Original Medicare covers, and by federal rule every C-SNP must also include Part D drug coverage. What's different is the design: because every enrollee shares the same underlying health need, the plan can build its provider network, its care coordination model, and its supplemental benefits — things like a diabetic-supply allowance or a cardiac rehab travel benefit — specifically around that one condition, at least in theory, rather than spreading a general-population benefit design across every kind of Medicare beneficiary.

C-SNPs are one of three Special Needs Plan types CMS recognizes. The other two exist locally: a D-SNP (Dual-Eligible Special Needs Plan) serves people who qualify for both Medicare and Medicaid, and an I-SNP (Institutional Special Needs Plan) serves people living in a nursing home or requiring that level of care. Minnehaha County has both of those. It does not have the third.

The 15 qualifying conditions

CMS doesn't leave "chronic condition" open to interpretation. A panel of clinical experts set a specific list back in 2008, and every C-SNP nationwide has to build its eligibility around one or more of these 15 categories, per CMS's own C-SNP page:

Source: CMS — Chronic Conditions Special Needs Plans (C-SNP), official 15-condition list.

A plan can be built around any single condition on that list. CMS also pre-approved five specific multi-condition groupings, where having just one of the listed conditions is enough to qualify, plus it allows insurers to design their own custom combinations as long as every condition in the combination still comes from the same 15-item list and the enrollee has all of them.

Source: CMS — Chronic Conditions Special Needs Plans (C-SNP), official 15-condition list.

Why C-SNP enrollment exploded nationally

This isn't a niche product anymore. KFF's own analysis of CMS Medicare Advantage enrollment data found national C-SNP enrollment grew from roughly 674,500 people in 2024 to about 1.15 million in 2025 — a jump of 476,300 enrollees, or 71%, in a single year. To put that scale in context, KFF's same analysis found Dual-Eligible Special Needs Plans, the far larger category at roughly 5.96 million enrollees, grew by only 159,400 people over the same period. For the first time on record, C-SNP growth outpaced D-SNP growth, and it accounted for more than three-quarters of all the growth across every Special Needs Plan type combined.

Source: KFF — A Closer Look at the Growing Role of Special Needs Plans in Medicare Advantage (Sept. 25, 2025).

KFF's analysis doesn't hand out a single tidy explanation for the surge, and neither will we — no source has verified one this session, so none appears here. What the same analysis does show clearly is where nearly all of that growth is concentrated: 97% of C-SNP plans nationally are built around diabetes or cardiovascular conditions, even though the official CMS list includes 13 other qualifying categories. If insurers are racing to build a new kind of plan right now, they're racing toward two conditions in particular — and those two happen to be exactly the ones showing up most in Minnehaha County's own health data, covered next.

Why this matters in Minnehaha County

Sioux Falls isn't a small market by South Dakota standards. Minnehaha County has 39,532 Medicare beneficiaries, per CMS's own county enrollment file — the largest Medicare population in the state. And the chronic-disease profile here lines up almost exactly with what C-SNPs are built for nationally.

Do the arithmetic on just the diabetes figure and it works out to roughly 3,953 Minnehaha County Medicare beneficiaries living with a diagnosis that, in a growing number of U.S. markets, would qualify them for a plan built specifically around it. Here, it doesn't change which plan type is on the shelf. That's not a criticism of any single carrier — insurers file new products with CMS market by market, and rural, lower-population states are consistently among the last places a new plan type reaches, a pattern that shows up across almost every Medicare product cycle, from Medicare Advantage itself in the 1990s to the newest supplemental benefit categories today. It is, however, exactly the kind of gap between the national Medicare conversation and the local reality that's worth knowing before you go looking for a plan that isn't there.

Layer in the county's coronary heart disease rate, 5.5% per the same CDC PLACES dataset, and its COPD rate, 5.6% — a chronic lung disorder that's also on CMS's 15-condition list — and a meaningful share of Minnehaha County's Medicare population has at least one condition a C-SNP somewhere in the country is already built around. None of that changes what a person here can actually enroll in this fall. It does mean the demand a national insurer would be chasing by launching a C-SNP in this market is genuinely present, even if no insurer has filed one yet.

What Sioux Falls actually has instead

Zero C-SNPs doesn't mean zero options. It means the options here are structured differently, and it's worth being precise about what that difference actually is rather than assuming a C-SNP would automatically be better anyway. CMS's own PY2026 Landscape file for South Dakota lists exactly five plan-type categories statewide, and a C-SNP line simply isn't one of them.

Source: CMS Medicare Advantage / Part D Landscape (PY2026), PY2026, statewide South Dakota.

Notice what's on that list: standard PPOs, stand-alone Part D drug plans, Medicare Cost plans, D-SNPs, and I-SNPs. No C-SNP row exists to fill in, in any county, for any carrier, for 2026. That's a straightforward reading of the same federal dataset CMS itself publishes for consumers to shop with — it isn't a judgment call or an estimate.

What Minnehaha County residents with a qualifying condition can reach today: a standard Medicare Advantage PPO open to anyone with Medicare (several of which add supplemental benefits worth checking, even without a chronic-condition restriction), a D-SNP if you also qualify for Medicaid, or an I-SNP if you live in a nursing home. None of the three is designed the way a C-SNP is designed. All three are real, currently enrollable options.

The full 2026 Minnehaha County roster

Here is the complete, real roster behind the 11-plan figure above — every Medicare Advantage plan carrying Part D drug coverage in Minnehaha County for 2026, broken out by type, per the same CMS Landscape file.

Standard PPOs — open to anyone with Medicare in the county

Dual-Eligible Special Needs Plans (D-SNP) — Medicare + Medicaid

Institutional Special Needs Plans (I-SNP) — nursing-home residents

Source: CMS Medicare Advantage / Part D Landscape (PY2026) & CMS Medicare Advantage & Part D Star Ratings (2026), Minnehaha County, 2026.

That's 5 + 4 + 2 = 11 Part C plans, matching the county's published 11-plan total. Two of the five standard PPOs carry a $0 monthly premium for 2026. None of the eleven is a C-SNP.

What to do if you have a qualifying condition

A missing plan type isn't the same as a missing option. If you have diabetes, heart disease, or another condition on CMS's 15-item list, here's what actually helps, in order.

1. Ask your primary care provider about Chronic Care Management (CCM). This is a real, separate Medicare Part B service — not a plan type — available to people managing two or more chronic conditions expected to last at least a year, per CMS's own care management guidance. Your own doctor's office bills Medicare for time spent coordinating your care between visits: medication reviews, care-plan updates, and communication with your other providers. It works under Original Medicare or a Medicare Advantage plan, and most Sioux Falls beneficiaries have never been offered it because it requires the practice to ask, and the patient to consent. A person managing diabetes and coronary artery disease together — two conditions squarely on CMS's own C-SNP list — meets the "two or more chronic conditions" threshold on the strength of that combination alone, with no C-SNP required to access this particular piece of coordinated care.
2. Read the Summary of Benefits for each standard PPO, not just the headline premium. A general-population plan can still include a meal benefit after a hospital stay, a diabetic-supply allowance, or added specialist visit coverage — check the actual document rather than assuming a plan without "special needs" in its name has nothing chronic-condition-specific to offer.
3. Confirm your endocrinologist, cardiologist, or other specialist is in-network before you enroll or switch, the same check that matters for any Medicare Advantage plan, chronic-condition-focused or not.
4. Check whether you qualify for a D-SNP. If you also have Medicaid, a D-SNP is a real option today, with $0 cost-sharing on the plans in this county, though it isn't restricted by chronic condition the way a C-SNP is.
5. Watch the CMS Landscape file again next fall. New plan types can and do arrive in new markets year over year. The only way to know for certain is to check when the PY2027 data is published, or have someone check it for you.

Original Medicare + Medigap vs. Advantage, for chronic condition management

With no C-SNP on the table, the more useful comparison in Sioux Falls right now is the same one every Medicare beneficiary here already faces: Original Medicare with a Medigap supplement, or a Medicare Advantage PPO. Chronic condition management looks different under each.

Neither structure replaces what a C-SNP is actually built to do — coordinate care specifically around one condition, with a network and supplemental benefits designed for it. Until one exists here, the honest comparison is between the general-population options above, weighed against your specific drugs, doctors, and budget.

How a local advisor helps with this

Everything above — reading a Summary of Benefits, asking your doctor about Chronic Care Management, checking a specialist's network status — is something you can do yourself, and plenty of people do. Where a conversation with us tends to help is plan comparison: sitting down with your actual drug list, your Sanford or Avera providers, and your budget, and matching them against the plans we offer here in Minnehaha County, rather than against a plan type the national ads describe that isn't actually on our shelf.

Big Sioux Benefits is a licensed independent agency here in Sioux Falls. We don't work for CMS, Medicare, or any single carrier — carriers pay us, not you, so the conversation costs nothing. We do not offer every plan available in your area; any information we provide is limited to those plans we do offer. For a full picture of every option, including anywhere a C-SNP might exist outside our service area, Medicare.gov, 1-800-MEDICARE, and your local State Health Insurance Program (SHIP) can help too.

You shouldn't have to become a Medicare product analyst to figure out that a plan type you heard about on TV isn't sold where you live. That's exactly the kind of gap between the national story and the local shelf we exist to walk through with you once, honestly, instead of leaving you to find out the hard way during Open Enrollment.

What to watch for in 2027

1. The CMS PY2027 Landscape file, typically published each fall — the only authoritative way to confirm whether a C-SNP has entered South Dakota, rather than relying on a carrier's national advertising.
2. National C-SNP enrollment continuing to outgrow D-SNP enrollment — if KFF's next annual analysis shows the same pattern, it signals insurers are still expanding this plan type quickly, which could eventually reach smaller markets like ours.
3. Your own plan's Annual Notice of Change each September — supplemental benefits tied to chronic conditions can be added or dropped year to year even without a C-SNP existing; we cover reading that letter line by line in our 2027 ANOC guide.
4. Whether your own doctor's office offers Chronic Care Management — ask directly rather than waiting to be offered it, since CMS requires patient consent to start it.
5. This year's Annual Enrollment Period, October 15 through December 7, 2026 — the window to compare the plans actually available here against your diagnosis before next year's coverage locks in.

How we know all this: Big Sioux Benefits runs every article through a data desk that cross-references CMS's own Special Needs Plan rules and PY2026 Medicare Advantage/Part D Landscape file, KFF's independent analysis of national Medicare Advantage enrollment trends, CDC PLACES county health data, and CMS's Physician Fee Schedule care management guidance — built by Strategic AI Architects. Every figure on this page was fetched from its primary source on September 9, 2026 and carries the period it covers. This is education, not medical or legal advice; confirm your own coverage questions with Medicare.gov, your plan, or a licensed agent. We take no payment from any carrier to feature a plan.