The Basics about Special Needs Plans
The Medicare Modernization Act of 2003 established a new type of
Medicare Advantage coordinated care plans called special needs
plans (SNPs) to focus on individuals with special needs.
Special needs individuals are defined as individuals who
institutionalized in a NF, SNF, ICF/MR or psychiatric facility
or persons living in the community with similar needs.
dually eligible for Medicare and Medicaid.
afflicted with severe or disabling chronic conditions.
Congress intended for SNPs to exclusively or disproportionately
enroll persons with serious chronic conditions to more effectively
serve high-risk populations through specialization. SNPs must offer
Medicare Parts A, B, and D benefits. SNPs function under most of
the same Medicare Advantage regulations, with some exceptions, and
use the same payment methodology as other MA plans. The most
significant exception relates to enrollment. Dual and institutional
beneficiaries can enroll in and disenroll from a SNP anytime
throughout the year. Chronic Condition beneficiaries have a
one-time special election period, based on their being diagnosed
with a condition that qualifies them for SNP enrollment.
As of April 2017, CMS had approved 284 MA contracts
offering 583 Special Needs Plans (SNPs) with a total enrollment of
2,357,538 beneficiaries. Of these 583 Special
Needs Plans, 123 are Chronic or Disabling Condition SNPs serving
334,969; 377 are Dual-Eligible SNPs serving 1,959,106
beneficiaries; and 83 Institutional SNPs are serving 63,463
beneficiaries. (Click to view the most recent monthly CMS'
This site contains access to application material, identifies
approved SNPs, and includes government-sponsored SNP reports and
other information about SNP development and implementation.
2016 SNP Alliance Profile Briefing
CMS Requirements for
April 2017 SNP