RESEARCH · METHODS
How we calculated the numbers in our Medicare "side door" op-ed
Each row shows a number from the op-ed, where the data came from, and the math. SOURCE marks public CMS data. CALCULATED marks numbers Carelytics worked out from that data.
METHODS TABLE| Number in the op-ed | Data source | How we calculated it | The counts |
|---|---|---|---|
| 93% of C-SNP members are in diabetes or heart plans | SOURCECMS monthly enrollment by contract, plan, state and county, Sept. 2026SOURCECMS plan landscape files (each plan's target conditions) | Members in C-SNPs that target diabetes, heart failure or cardiovascular disorders ÷ all C-SNP members | CALCULATED1,700,244 ÷ 1,819,733 = 93.4% CMS's own SNP report gives 93.3%. |
| Growth has nearly stopped outside SNPs: −0.2%, or about +0.6% adjusted | SOURCECMS Medicare Monthly EnrollmentSOURCECMS SNP Comprehensive Reports | Medicare Advantage and other private plans, minus all SNP members, June 2025 vs. June 2026. Adjusted: add back the 216,872 members who moved when demonstration plans closed | CALCULATED27,788,472 → 27,742,034 = −0.17% With the 216,872 added back = +0.61% |
| 63% of Medicare Advantage's net growth | Same two sources as the row above | C-SNP members added ÷ all Medicare Advantage members added, June 2025 to June 2026 | CALCULATED482,066 ÷ 762,104 = 63.3% |
| 50% of C-SNPs' growth came after March (2025) | SOURCECMS SNP Comprehensive Reports, Dec. 2024, Mar. 2025 and Dec. 2025 | (Dec. 2025 − Mar. 2025) ÷ (Dec. 2025 − Dec. 2024) | CALCULATED276,925 ÷ 556,806 = 49.7% |
| The share was 17% for other private plans (2025) | Medicare Monthly Enrollment and SNP reports, same months | Same formula, for Medicare Advantage outside SNPs | CALCULATED78,160 ÷ 468,731 = 16.7% |
| 97% of C-SNP members have a food benefit (vs. 10%) | SOURCECMS plan benefit files, 2026Enrollment by plan, Sept. 2026 | Within the 125 insurance contracts that sell both a diabetes C-SNP and a regular plan: share of members in plans that offer a food or produce benefit, weighted by enrollment | CALCULATED1,747,742 C-SNP members: 97% 10,915,011 regular-plan members: 10% |
What is a C-SNP? A Chronic Condition Special Needs Plan. It is a type of Medicare Advantage plan for people with certain long-term illnesses. An SNP is any Special Needs Plan.
Questions about our data or math? Email contact@carelyticsllc.com.