← Back to list
26-1291 2027 Medicare Advantage and Special Needs Plan Updates: What You Need to Know
Effective date
Jan 1, 2027
Identified
Nov 4, 2026
Summary
Effective January 1, 2027, Wellcare By Health Net is restructuring Medicare Advantage, D-SNP, and C-SNP plans across California counties, including plan name changes, plan segmentation, one plan termination, a new dental vendor (Liberty Dental Plan), and expansion of SSBCI benefits to D-SNP members. The practice must verify member plan assignments and benefits before rendering services, update charge entry to reflect accurate diagnosis codes for SSBCI eligibility, confirm dental network participation with the new vendor, and respond promptly to member attestation requests for C-SNP enrollment.
Get alerts when payers change rules like this one
We check Health Net and other payers every day and email you when a change matches your specialty and state.
Get Health Net alertsPolicy Monitoring is free. No card required.
What to do
Action · 11 steps
01Effective January 1, 2027:
1. Billing team and front desk staff: Verify coverage and plan assignment before scheduling or billing services.
02Review each plan's Annual Notice of Change and Member Handbook/Evidence of Coverage to confirm current benefits for affected members.
032. Billing team: Update charge entry to ensure accurate diagnosis coding on all claims submitted to Wellcare By Health Net D-SNP members enrolled in Wellcare CalViva Health Dual Align (H3561-007), Wellcare Health Net Dual Align (H3561-010-001 and H3561-010-002), or Wellcare Dual Liberty (H3561-009), as diagnosis codes trigger automated SSBCI benefit eligibility qualification.
043. Providers: Respond promptly to member letters requesting provider attestation to verify chronic condition eligibility for C-SNP new enrollees.
05The plan will contact the provider within three business days requesting verbal or faxed attestation.
064. Billing team and credentialing: Contact Liberty Dental Plan ahead of January 1, 2027 to confirm network participation for dental providers.
07Existing Delta Dental (D-SNP/C-SNP) and DBP (MA plans) referrals and authorizations will not carry over; members will receive new dental ID information.
085. Front desk staff and billing team: Alert members affected by plan segmentation (H3561-008 splitting into H3561-010-001 for Los Angeles County and H3561-010-002 for Amador, Calaveras, Inyo, Mono, Sacramento, San Joaquin, Stanislaus, Tulare, and Tuolumne counties) that they will receive new ID cards; no member action is required.
096. Front desk staff and billing team: Note that Wellcare Low Premium (HMO) MA Plan H0562-133 is terminated effective December 31, 2026, affecting members in Amador and Yolo counties.
10Members were notified in early October 2026 of their Medicare options.
117. Billing team: Use updated plan names for claim submission: H0562-012 and H0562-097 are now Wellcare Low Premium Focus (HMO); H3561-009 is now Wellcare Health Net Dual Liberty (HMO D-SNP).
Original notice
26-1291 2027 Medicare Advantage and Special Needs Plan Updates: What You Need to Know
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.