Special Needs Plans (SNP) account for an increasing share of growth in the Medicare Advantage (MA) program. Enrollment in SNPs increased by 215 percent from 2018 to 2026, relative to just 49 percent growth in general MA. Nearly 1 in 4 Medicare Advantage members are now enrolled in a SNP. This growth reflects both demand among high-need beneficiaries and SNPs’ emergence as a core platform for addressing complex clinical, functional, and social risk profiles that traditional Medicare and general MA plans were not originally structured to manage. For MA organizations, SNPs have also become a strategic growth opportunity. This growth has also prompted increased policy interest in how SNP frameworks might be leveraged further to improve health outcomes and system performance for high-need populations.
In our new issue brief, ATI Advisory examines how SNPs are fundamentally different from general MA plans, serving populations with substantially higher clinical complexity, functional impairment, and social risk. Our analysis shows SNP members have, on average, 51 percent higher risk scores than general MA members; experience higher rates of chronic illness; and more frequently experience frailty and ADL needs. SNPs operate under more rigorous federal and state requirements, invest in intensive care coordination and interdisciplinary models of care, and are more likely to deploy non-medical supplemental benefits to address functional and social needs that traditional Medicare does not cover.
As policymakers and stakeholders increasingly look to SNPs as a platform for addressing Medicare’s highest-need populations, it is critical to understand what makes them work, how they differ in practice from general MA, and what those differences imply for policy, payment, and accountability.