Where is the D-SNP marketing opportunity?
The current cross-vintage proxy shows a 5,767,705 gap between the April 2026 dual population and August 2026 reported D-SNP enrollment. This is a market-sizing proxy, not a verified count of beneficiaries currently eligible and available to enroll. The gap is the national headline, and it is close to useless on its own: capture runs from the high teens to the low seventies by state, and the marketing problem in a low-capture state is nothing like the marketing problem in a high-capture one. This page splits the country by the structure that actually changes the plan.
Enrollment, integration and plan counts are the August 2026 CMS SNP Comprehensive Report. Dual population is the April 2026 CMS county file. The capture proxy is August 2026 state D-SNP enrollment divided by April 2026 state dual population: a cross-vintage market-sizing indicator, not a same-month enrollment rate. Same definition as the SNP page.
Largest proxy uncaptured dual opportunity
California
New York
Illinois
Texas
Massachusetts
D-SNP market structure by state
Contract counts by integration status are not additive. A contract can contain plan benefit packages with more than one integration status, so CO + HIDE + FIDE contract counts sum to more than the distinct D-SNP contract total. Plan counts and enrollment are additive; contract counts are not, and are never summed into a national contract total on this site.
| State | Duals | D-SNP enrollment | Capture proxy Aug 2026 D-SNP enrollment / Apr 2026 dual population | Proxy gap | Contracts | HHI | Largest carrier | FIDE + HIDE | Archetype |
|---|---|---|---|---|---|---|---|---|---|
| California | 1,797,355 | 515,735 | 28.7% | 1,281,620 | 40 | 2,197 | Other / independent 28.1% | 5.4% | Untapped dual market |
| New York | 1,180,562 | 762,250 | 64.6% | 418,312 | 28 | 3,087 | CVS Health / Aetna 43.2% | 77.2% | Competitive switcher market |
| Illinois | 394,426 | 84,949 | 21.5% | 309,477 | 17 | 2,708 | Humana 32.5% | 100.0% | Untapped dual market |
| Texas | 683,674 | 426,414 | 62.4% | 257,260 | 35 | 3,543 | UnitedHealth Group 52.3% | 30.7% | Competitive switcher market |
| Massachusetts | 374,447 | 117,816 | 31.5% | 256,631 | 12 | 5,145 | Other / independent 66.9% | 100.0% | Untapped dual market |
| Florida | 928,134 | 682,787 | 73.6% | 245,347 | 31 | 2,758 | UnitedHealth Group 36.9% | 93.7% | Competitive switcher market |
| Pennsylvania | 475,344 | 258,914 | 54.5% | 216,430 | 20 | 5,049 | Other / independent 66.1% | 30.0% | Developing / balanced market |
| Michigan | 338,248 | 163,916 | 48.5% | 174,332 | 22 | 2,051 | Humana 27.2% | 47.3% | Untapped dual market |
| Ohio | 402,562 | 258,463 | 64.2% | 144,099 | 19 | 2,463 | UnitedHealth Group 35.7% | 29.9% | Competitive switcher market |
| Oregon | 169,911 | 31,708 | 18.7% | 138,203 | 14 | 7,502 | Other / independent 85.4% | 97.6% | Untapped dual market |
| New Jersey | 231,704 | 99,474 | 42.9% | 132,230 | 7 | 4,209 | Other / independent 57.7% | 100.0% | Untapped dual market |
| Georgia | 380,910 | 252,926 | 66.4% | 127,984 | 20 | 3,495 | UnitedHealth Group 51.4% | 0.0% | Competitive switcher market |
| North Carolina | 359,194 | 234,278 | 65.2% | 124,916 | 20 | 5,260 | UnitedHealth Group 68.9% | 0.0% | Competitive switcher market |
| Arizona | 251,428 | 128,235 | 51.0% | 123,193 | 21 | 9,945 | Other / independent 99.7% | 100.0% | Integration-led market |
| Maryland | 155,956 | 40,976 | 26.3% | 114,980 | 9 | 2,451 | UnitedHealth Group 38.1% | 0.0% | Developing / balanced market |
| Tennessee | 236,173 | 133,940 | 56.7% | 102,233 | 12 | 5,118 | UnitedHealth Group 57.7% | 48.7% | Integration-led market |
| Minnesota | 138,638 | 38,879 | 28.0% | 99,759 | 10 | 10,000 | Other / independent 100.0% | 100.0% | Integration-led market |
| Washington | 237,938 | 140,385 | 59.0% | 97,553 | 13 | 5,489 | UnitedHealth Group 72.3% | 46.7% | Competitive switcher market |
| Connecticut | 208,491 | 113,059 | 54.2% | 95,432 | 8 | 3,540 | UnitedHealth Group 47.8% | 0.0% | Developing / balanced market |
| Indiana | 222,265 | 136,142 | 61.3% | 86,123 | 12 | 5,988 | UnitedHealth Group 72.2% | 45.5% | Concentrated leader market |
| Virginia | 204,237 | 118,332 | 57.9% | 85,905 | 15 | 2,942 | UnitedHealth Group 40.1% | 72.9% | Competitive switcher market |
| Wisconsin | 179,860 | 97,607 | 54.3% | 82,253 | 13 | 4,191 | UnitedHealth Group 54.8% | 99.4% | Integration-led market |
| Missouri | 189,954 | 107,895 | 56.8% | 82,059 | 17 | 3,696 | UnitedHealth Group 57.2% | 0.0% | Competitive switcher market |
| Alabama | 225,453 | 149,304 | 66.2% | 76,149 | 12 | 3,326 | UnitedHealth Group 46.9% | 0.0% | Developing / balanced market |
| Kentucky | 179,170 | 103,844 | 58.0% | 75,326 | 15 | 3,732 | UnitedHealth Group 55.6% | 90.3% | Competitive switcher market |
| South Carolina | 174,819 | 105,859 | 60.6% | 68,960 | 11 | 3,799 | UnitedHealth Group 50.1% | 34.4% | Concentrated leader market |
| Colorado | 127,738 | 66,897 | 52.4% | 60,841 | 17 | 3,858 | UnitedHealth Group 56.9% | 0.0% | Developing / balanced market |
| Louisiana | 223,850 | 164,070 | 73.3% | 59,780 | 14 | 3,376 | Other / independent 41.3% | 0.0% | Competitive switcher market |
| Mississippi | 163,247 | 105,870 | 64.9% | 57,377 | 15 | 3,011 | Humana 41.9% | 0.0% | Competitive switcher market |
| Oklahoma | 119,016 | 62,991 | 52.9% | 56,025 | 14 | 4,701 | UnitedHealth Group 58.4% | 0.0% | Developing / balanced market |
| Maine | 105,625 | 51,302 | 48.6% | 54,323 | 8 | 2,988 | UnitedHealth Group 45.5% | 0.0% | Developing / balanced market |
| Nevada | 85,432 | 32,816 | 38.4% | 52,616 | 16 | 2,835 | Humana 43.1% | 0.0% | Developing / balanced market |
| Arkansas | 132,305 | 80,541 | 60.9% | 51,764 | 13 | 4,121 | UnitedHealth Group 59.3% | 0.0% | Competitive switcher market |
| Kansas | 69,234 | 24,410 | 35.3% | 44,824 | 10 | 6,495 | UnitedHealth Group 79.1% | 91.5% | Integration-led market |
| Iowa | 86,142 | 42,045 | 48.8% | 44,097 | 8 | 4,028 | UnitedHealth Group 60.5% | 19.3% | Developing / balanced market |
| West Virginia | 83,399 | 39,813 | 47.7% | 43,586 | 7 | 4,348 | UnitedHealth Group 58.6% | 0.0% | Developing / balanced market |
| New Hampshire | 30,707 | 0 | 0.0% | 30,707 | 1 | n/a | n/a | 0.0% | Developing / balanced market |
| Idaho | 52,761 | 22,055 | 41.8% | 30,706 | 6 | 5,178 | Molina Healthcare 59.4% | 76.4% | Integration-led market |
| Delaware | 32,967 | 8,481 | 25.7% | 24,486 | 7 | 5,012 | Highmark 52.5% | 68.3% | Integration-led market |
| Nebraska | 43,874 | 23,789 | 54.2% | 20,085 | 10 | 5,862 | UnitedHealth Group 75.3% | 84.5% | Integration-led market |
| Montana | 24,500 | 5,848 | 23.9% | 18,652 | 3 | 6,891 | Humana 80.7% | 0.0% | Developing / balanced market |
| District of Columbia | 34,310 | 16,990 | 49.5% | 17,320 | 2 | 10,000 | UnitedHealth Group 100.0% | 58.5% | Integration-led market |
| Hawaii | 48,187 | 32,456 | 67.4% | 15,731 | 6 | 5,042 | UnitedHealth Group 67.1% | 100.0% | Concentrated leader market |
| South Dakota | 20,374 | 4,833 | 23.7% | 15,541 | 2 | 6,998 | UnitedHealth Group 81.6% | 0.0% | Developing / balanced market |
| Rhode Island | 45,058 | 30,493 | 67.7% | 14,565 | 8 | 3,837 | Other / independent 44.4% | 36.2% | Developing / balanced market |
| Utah | 34,889 | 21,748 | 62.3% | 13,141 | 11 | 3,088 | UnitedHealth Group 46.5% | 0.0% | Developing / balanced market |
| North Dakota | 14,917 | 2,235 | 15.0% | 12,682 | 3 | 6,779 | UnitedHealth Group 79.8% | 0.0% | Developing / balanced market |
| Wyoming | 12,042 | 1,332 | 11.1% | 10,710 | 1 | 10,000 | UnitedHealth Group 100.0% | 0.0% | Developing / balanced market |
| New Mexico | 45,780 | 44,400 | 97.0% | 1,380 | 11 | 4,717 | UnitedHealth Group 49.4% | 97.9% | Integration-led market |
| Puerto Rico | 5,415 | 308,050 | suppressed | 0 | 4 | 5,849 | Other / independent 70.6% | 100.0% | Capture ratio suppressed |
HHI is the Herfindahl-Hirschman index over parent organizations, computed on single-state D-SNP plans only. A plan sold across several states carries one CMS enrollment figure that cannot be split by state, so attributing it to each state would invent enrollment; the unattributed share is reported rather than hidden. Puerto Rico's capture ratio is suppressed because block-grant Medicaid makes its dual denominator non-comparable.
The four archetypes, and the rule that assigns each one
These are deterministic thresholds over the state distribution, not judgment calls. A state can qualify for more than one; the table shows the first match in the order below and the underlying figures are all in the table above so you can disagree with the label.
| Archetype | Rule | What it implies for marketing |
|---|---|---|
| Untapped dual market | Dual population at or above the state median, and D-SNP capture in the bottom 40% of states. | The addressable base exists and is not yet enrolled. Acquisition messaging, community and provider channels, and year-round activity rather than an AEP burst. |
| Competitive switcher market | Capture in the top 40% of states and a contract count at or above the median. | Growth comes from switching, not from finding new duals. Differentiation and retention matter more than reach, and share of voice is expensive. |
| Concentrated leader market | Capture in the top 40% of states and a single parent organization holding 50% or more of attributable D-SNP enrollment. | One carrier sets the local benchmark. Entering means arguing against a known incumbent benefit set; defending means protecting a position competitors will attack on service. |
| Integration-led market | FIDE and HIDE plans account for 40% or more of state D-SNP enrollment. | Integration is a real, checkable product difference here. Message the care experience the integration actually delivers, and confirm your own product's category before saying so. |
| Developing / balanced market | No threshold met. | Read the underlying figures rather than the label. These markets usually turn on something local that a national ranking cannot see. |
modeled Archetype assignment is derived, version 0.1. The inputs are published CMS counts; the thresholds are MedicareInsights choices and are stated here so they can be argued with.
So what / Now what Interpretation
The capture proxy and dual population point in different directions often enough that a national duals strategy is almost always wrong. A large proxy opportunity in a low-capture state is an acquisition problem solved with reach, community channels and year-round activity. The same sized pool in a high-capture, concentrated state is a switching problem solved with differentiation and service proof, at a much higher cost per member. The archetype is there to stop those two being funded the same way.
- Sort by the proxy uncaptured dual opportunity to size the prize, then read the archetype column before deciding what kind of campaign it is.
- In integration-led markets, confirm your own product category, coordination-only, HIDE or FIDE, before any messaging about integrated care. This is the most common compliance snag in D-SNP creative.
- Duals hold enrollment rights outside AEP. If the media plan for a duals product is shaped like an AEP plan, most of the year is unworked, see the calendar.
- Take the shortlist to D-SNP deployment so community and field partnerships are pointed at the same states.
Limitations you should carry into the meeting
- Four of the nine MA components are not yet computable. The score therefore measures market attractiveness for marketing investment, not competitive winnability.
- D-SNP capture, competitive openness and integration readiness are published by CMS at state level. Applying them to a county assumes the county behaves like its state.
- Carrier concentration attributes only single-state D-SNP plans. Plans sold across several states carry one CMS enrollment figure that cannot be split by state; the unattributed share is reported per state.
- Counties below the reliability floor are flagged, not hidden.
- Nothing here describes an individual beneficiary. Every figure is a published geography-level aggregate.
- National D-SNP capture is computed on the same basis as /market/snp/ (all state rows, Puerto Rico included). Puerto Rico's own ratio is suppressed everywhere it would be displayed, because block-grant Medicaid makes its dual denominator non-comparable.
Sources and vintage
| Dataset | Source | Vintage | Status |
|---|---|---|---|
| MA and other health plan enrollment and share by county | CMS Medicare Monthly Enrollment (BENE_GEO_LVL=County) | April 2026 | live |
| Dual-eligible counts by county | CMS Medicare Monthly Enrollment (DUAL_TOT_BENES / FULL_DUAL_TOT_BENES) | April 2026 | live |
| SNP enrollment, integration and plans | CMS SNP Comprehensive Report (SNP_REPORT_PART_17) | August 2026 | live |
| Marketing Opportunity Score | Derived, tools/build_marketing_data.py v0.1 | 2026-08-26 | modeled |
Full methodology: Marketing Opportunity Score · site methodology.