Medicare AdvantageAdministrativeHigh impact
25-1184sum Summary Update: 2026 Medicare Advantage and D-SNP Updates: What Providers Need to Know
Health Net·CA·Coding
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Effective January 1, 2026, significant Medicare Advantage and D-SNP plan changes will occur including county-level plan transitions, new coverage areas, and plan terminations. Providers must watch for new member ID cards, ensure accurate diagnosis coding, and respond promptly to plan verification requests within three business days for C-SNP enrollments.
Action Required
By January 1, 2026: Billing team must watch for new Medicare Advantage member ID cards and updated eligibility files. Verify member eligibility before each visit due to plan transitions and terminations. Providers must verify chronic conditions for new C-SNP enrollees with required attestation within three business days. Ensure accurate diagnosis coding on all claims to support D-SNP supplemental benefits eligibility. Update patient insurance information immediately upon receiving new member cards to avoid claim denials.