About SNPs

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 are:

  • 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 August 2017, CMS had approved 284 MA contracts offering 583 Special Needs Plans (SNPs) with a total enrollment of 2,423,225 beneficiaries. Of these 583 Special Needs Plans, 123 are Chronic or Disabling Condition SNPs serving 343,209; 377 are Dual-Eligible SNPs serving 2,029,440 beneficiaries; and 83 Institutional SNPs are serving 66,576 beneficiaries. (Click to view the most recent monthly CMS' Comprehensive Report.)

This site contains access to application material, identifies approved SNPs, and includes government-sponsored SNP reports and other information about SNP development and implementation.

The Basics

2016 SNP Alliance Profile Briefing

CMS Requirements for SNPs

August 2017 SNP Report

Special Needs Plans Reports

NHPG Policy Guidance