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

Fact Sheet

Fact Sheet: Health Assessments in Medicare Advantage August 16, 2024

Health assessments, also commonly known as health risk assessments, are an established component of the Medicare program. This fact sheet offers an overview of health assessments, how they’re utilized in Medicare Advantage, and they value…

Home Care

Patient Centered Care

Risk Adjustment

Report

Case Study Report: Innovative Approaches to Addressing Social Determinants of Health for Medicare Advantage Beneficiaries January 26, 2022

This case studies report, prepared by NORC at the University of Chicago and commissioned by Better Medicare Alliance’s Center for Innovation in Medicare Advantage, highlights best practices in addressing social determinants of health (SDoH) for…

Flexibility in Benefit Design

Special Needs Plans

White Paper

The COVID-19 Response: Differences in Medicare Advantage and Fee-For-Service Medicare in Meeting Beneficiary and Provider Needs November 4, 2021

This white paper, conducted by Health Management Associates (HMA) and commissioned by Better Medicare Alliance, evaluates the Medicare Advantage community’s response to COVID-19 and key differences in Medicare Advantage and fee-for-service (FFS) Medicare’s abilities to…

Patient Centered Care

Health Outcomes