Special Needs Plans are a type of Medicare Advantage plan that is allowed to selectively market and enroll Medicare beneficiaries with special needs.  Special Needs Plans (SNPs) offer the opportunity to improve care for Medicare beneficiaries with special needs, primarily through improved coordination and continuity of care.  SNPs must also meet additional standards for care delivery and quality of care.

Today, about 1.4 million Medicare beneficiaries receive their Medicare Part A and Part B services and Medicare Part D drug benefits through SNPs.  Together with Medicaid health plans, Medicare Advantage SNPs will play key role in the new integrated Medicare-Medicaid health plan demonstrations now under development in numerous states.

There are three kinds of Medicare Advantage Special Needs Plan:

  • Special Needs Plan for Medicare-Medicaid dual eligibles (D-SNP).
  • Special Needs Plan for Medicare beneficiaries with severe, chronic or disabling conditions (C-SNP).
  • Special Needs Plan for Medicare beneficiaries needing an institutional level of care (I-SNP).

Enrollment in SNPs reached 1,396,000 in 2012, up from 1,284,000 in 2011.  Specifically, in 2012:

  • 83% (1,158,000) are dual eligibles enrolled in D-SNPs.
  • 13.8% (192,000) are enrolled in C-SNPs – 90% of whom are in SNPs designed to care for persons with chronic heart failure, cardiovascular disease, and/or diabetes.
  • 3.4% (46,000) are in I-SNPs.

A helpful brief from the Kaiser Family Foundation highlights data on Medicare Advantage and SNP enrollment in 2012.

Within the dual eligible SNPs, there are five different types of D-SNPs that CMS-approved Medicare Advantage organizations (MAO) may offer, depending on their coordination contract with the state Medicaid agency:

  1. All-Dual D-SNPs: Medicare and Medicaid dual eligibles may enroll.
  2. Full-Benefit D-SNPs: Medicare beneficiaries and those eligible for full Medicaid benefits may enroll.
  3. Medicare Zero-cost-sharing D-SNPs: Qualified Medicare beneficiaries (QMB) and QMBs eligible for comprehensive Medicaid benefits (QMB+) can enroll.
  4. Fully Integrated Dual Eligible (FIDE) SNPs: the plan meets CMS’ definition for full integration of Medicare and Medicaid benefits.
  5. Dual Eligible Subset D-SNPs: a subset of dual eligibles as agreed to by the state Medicaid agency and the Medicare Advantage Organization in the state-MAO contract can enroll.

Starting in 2013, all new and existing D-SNPs will be required to contract with the state Medicaid agency in which the Medicare Advantage organization wants to operate a D-SNP.

In terms of network design, Special Needs Plans may be based on any of the three primary models of Medicare Advantage (MA) coordinated care plan (CCP): health maintenance organization (HMO), local preferred provider organization (PPO), or regional preferred provider organization (RPPO). However, of all Special Needs Plans, 88% are HMOs and the rest are either local or regional PPOs.

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