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Spotlight on Innovation

Spotlight on Innovation: Medicare Advantage Special Needs Plans

Overview

Special Needs Plans (SNPs) are a type of Medicare Advantage plan that specializes in care for the health care system’s fastest growing and most costly and complex care beneficiaries – frail, disabled, and chronically-ill Medicare beneficiaries.1 2 SNPs are authorized to tailor services and models of care to the unique population they serve through the Medicare Advantage framework. SNPs are paid in the same way as Medicare Advantage plans, and required to offer all Medicare Part A and B benefits. SNPs are also required to comply with the same Medicare Advantage program and reporting requirements. Targeted populations include beneficiaries who are dually-eligible for Medicare and Medicaid, have certain chronic conditions, or are living in an institution or in the community and require an institutional level of care.

The Medicare Modernization Act of 2003 established the SNP program and enabled Medicare Advantage plans to target care to beneficiaries by creating three types of SNPs: Dual-Eligible SNPs (D-SNPs), Chronic Condition SNP (C-SNPs), and Institutional SNP (I-SNPs).3 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended the SNP program through December 31, 2018. Congressional action is necessary to extend the program to ensure continuity in care to the population of beneficiaries served by SNPs.4