Bexar County Medicare Daily Brief: 13.8% Diabetes Rate, 4,265 SNP Elections, and What San Antonio Seniors with Kidney Disease Must Know Today

What is the overall Medicare plan landscape in Bexar County today?

Texas is, by raw numbers, the most competitive Medicare Advantage market in our dataset. As of the 2026 plan year, CMS.gov Medicare Plan Finder shows 410 Medicare Advantage plans available across the state — offered by 23 carriers operating in 255 of Texas's 254 counties (yes, that math is CMS's, not ours). The average star rating across Texas plans is 3.64 stars — above the 3.5-star threshold that triggers CMS bonus payments to carriers, which means a lot of carriers in this state are collecting bonuses while seniors are still reading their EOBs trying to figure out what changed.

Bexar County — home to San Antonio, the 7th-largest city in the United States and a population of 2,087,679 — sits at the epicenter of that market. For a senior with chronic kidney disease (CKD) or end-stage renal disease (ESRD), the sheer volume of plan options is both a gift and a trap. More choice means more fine print. More fine print means more ways for a carrier to technically be "in network" until the nephrology referral hits a wall at the authorization desk.

The SNP number deserves its own paragraph. Texas's 4,265 SNP plan elections is the highest figure in our current national data — higher than Florida (2,022), higher than Ohio (2,708), higher than Georgia (4,910). Wait — Georgia edges it out. Fine. Texas is #2. But here's the thing that makes that number meaningful for kidney disease specifically: SNPs include Chronic Special Needs Plans (C-SNPs), which are specifically designed for people with serious or chronic conditions including CKD stage 4-5, ESRD, and dialysis dependence. These plans can offer reduced copays for dialysis sessions, dedicated care coordinators, and prior authorization pathways specifically tuned to nephrology. Most Bexar County seniors with kidney disease are not on one. That is the gap this article is built around.

How bad is the kidney disease risk profile in Bexar County — and what does the data actually say?

Let's talk about what CDC PLACES 2023 data shows for Bexar County, because if you're a senior with kidney disease here, you're living inside a very specific set of numbers — and those numbers explain exactly why your Medicare plan choice matters more than it does in, say, suburban Denver.

First: 13.8% diagnosed diabetes rate among adults. Diabetes is the single largest cause of CKD in the United States, responsible for roughly 38% of all new ESRD cases per year according to the USRDS (U.S. Renal Data System). In Bexar County, with a population of 2,087,679, that 13.8% rate means approximately 288,000 adults are carrying a diagnosed diabetes diagnosis — and a significant portion of those will develop or already have some degree of kidney dysfunction. (The undiagnosed population doesn't appear in this number. It's a feature of how the data is collected, not a comfort.)

Second: 34.2% obesity rate (CDC PLACES 2023). Obesity is the second leading cause of CKD, independently associated with kidney damage even without diabetes. For a county where more than 1 in 3 adults are obese, the downstream dialysis and transplant burden on the Medicare system — and on individual plan benefits — is not hypothetical. It is already here.

Third: 3.0% stroke prevalence (CDC PLACES 2023). Stroke and kidney disease share an important link: cardiovascular disease is both a cause and a consequence of CKD. Seniors managing both conditions simultaneously need plans that cover nephrology, cardiology, and rehabilitation without requiring separate network lookups for each specialist.

That mobility disability number — 14.3% — is more consequential than it looks on a health outcomes chart. Dialysis is not an appointment you can reschedule. In-center hemodialysis is typically three sessions per week, each lasting three to four hours. If your plan doesn't cover transportation to dialysis, you are looking at either out-of-pocket Uber costs adding up to hundreds of dollars per month, or you are skipping sessions. Neither is a good option. C-SNPs often include non-emergency medical transportation (NEMT) as a supplemental benefit. Many standard Medicare Advantage HMO plans do not.

Which hospitals in San Antonio actually serve Medicare seniors with kidney disease — and what are their CMS ratings?

Bexar County has 10 Medicare-registered hospitals in the CMS Hospital Compare dataset. For a senior with CKD or ESRD, not all 10 are equally relevant. Here's the full landscape, filtered for kidney care relevance:

University Health System is the county's public academic medical center — and the most important hospital for uninsured, low-income, and dual-eligible seniors with complex conditions like CKD. It operates a nephrology department and serves as a safety-net provider for patients whose private plans have narrow networks. If your Medicare Advantage plan doesn't include University Health in network, that is a fact worth knowing before you need a nephrology consult at 2 a.m.

The San Antonio VA Medical Center (5 stars, (210) 617-5300) is the only hospital in the county earning a top CMS rating. Veterans with CKD who are Medicare-eligible should know they can use both systems simultaneously in many circumstances — VA for primary CKD management, Medicare for supplemental coverage and specialist access. (That coordination is not automatic. It requires active enrollment in both systems and a clear understanding of which system bills for what service.)

The four major civilian acute-care hospitals — University, Baptist, Methodist, and CHRISTUS Santa Rosa — all sit at 3 stars on CMS Hospital Compare. Three stars means "average." It does not mean "bad." But it also does not mean "excellent." For a senior choosing a Medicare Advantage plan partly based on hospital quality, this data belongs in the same spreadsheet as the premium.

What are Chronic Special Needs Plans (C-SNPs) and why do Bexar County kidney patients need to look at them now?

Here is the part of the article where I tell you something that the carrier's marketing materials will not: most Medicare Advantage plans are not designed for people who are seriously ill. They are designed for people who are 65, relatively healthy, and will consume moderate amounts of outpatient care. The actuarial model works great for that population. For a senior with CKD stage 4 who goes to dialysis three times a week and sees a nephrologist monthly, a standard HMO plan is a financial instrument that was calibrated for someone else.

Enter the Chronic Special Needs Plan (C-SNP). C-SNPs are a category of Medicare Advantage plan specifically authorized by Congress to serve people with severe or disabling chronic conditions, including:

• Chronic Kidney Disease (CKD), stages 4 or 5
• End-Stage Renal Disease (ESRD) requiring dialysis
• Diabetes (often packaged with CKD in combo C-SNPs)
• Cardiovascular disorders (relevant given Bexar's 3.0% stroke rate)

C-SNPs must, by CMS regulation, provide an Individualized Care Plan (ICP) for each enrollee, a care coordinator (typically a nurse or social worker), and benefits specifically tailored to the qualifying condition. That can mean: lower dialysis session copays, transportation to dialysis included, nutritional counseling (renal diets are complicated), and formulary tiers structured to keep immunosuppressants and phosphate binders affordable.

Texas has 4,265 SNP plan elections statewide across all SNP types (C-SNP, D-SNP for dual-eligibles, and I-SNP for institutionalized seniors). That is the second-largest SNP market in our national dataset. Bexar County, as one of Texas's largest counties, carries a significant portion of that volume. Yet CMS enrollment data consistently shows that C-SNP enrollment lags far behind D-SNP enrollment — in part because the D-SNP marketing machine (dual-eligible = both Medicare and Medicaid, which means carriers get paid twice) is funded at a level that C-SNP marketing simply isn't. The carrier making $15M in CEO compensation is not spending proportionate resources making sure a CKD patient in San Antonio's West Side knows C-SNPs exist. You can do the math on that one.