20 things to know about the fastest growing form of Medicare Advantage

Special needs plans, Medicare Advantage plans for individuals with chronic or disabling conditions, are growing faster than the general MA program. 

Here are 20 facts and figures to know about who SNPs serve, how they work and their rapid growth. 

Enrollment Profile

  1. 12.5 million people nationwide are jointly enrolled in Medicare and Medicaid, a Kaiser Family Foundation analysis found. This accounts for 20 percent of the total Medicare population. 

  2. Of these, around 5.5 million are enrolled in Medicare Advantage special needs plans. 

  3. Dual-eligible beneficiaries are a heterogeneous group in terms of age and physical and mental health status, according to Kaiser Family Foundation. Of dual-eligible enrollees, 87 percent have an annual income of less than $20,000, and 40 percent have an annual income of less than $10,000. 

  4. Dual-eligibles are younger than the general Medicare population — 40 percent are under 65 and eligible for Medicare because they have received 24 months of Social Security disability payments. 

  5. Around 13 percent of dual-eligible beneficiaries live in long-term care or other institutional facilities, compared with 1 percent of all Medicare beneficiaries. 

  6. Around half of dual-eligible beneficiaries are people of color, compared to around 20 percent of the general Medicare population. 

  7. Different states have different standards for Medicaid and Medicare dual-eligibility. The District of Columbia has the highest proportion of dual-enrolled individuals, making up 38 percent of the Medicare population. 

  8. Utah has the smallest proportion of dual-eligible enrollees, accounting for 10 percent of the Medicare population. 


  1. Dual-eligible enrollees account for a higher share of spending than the general population. In traditional Medicare, dual-eligible enrollees account for 17 percent of the population, but 33 percent of spending. (MA spending data is not available, KFF notes in its analysis.) 

  2. Around 44 percent of dual-eligible beneficiaries are in fair or poor health, compared with 17 percent of Medicare beneficiaries without Medicaid, and are more likely to have conditions linked to higher spending. 

Special needs Medicare Advantage plans 

  1. There are three types of MA special needs plans: D-SNP for dual-eligible enrollees, C-SNP for certain chronic or disabling conditions, and I-SNP for individuals receiving institutional care. 

  2. Special needs plans were first introduced in 2006, when the Medicare Advantage program took its current form. 

  3. D-SNPs account for the vast majority of special needs plans enrollees. For 2023, 4.9 million people are enrolled in D-SNPs, compared with 450,000 in C-SNPs and 107,000 in I-SNPs, according to an analysis from consulting firm Chartis. 

  4. Most C-SNPs are focused on care for diabetes or cardiovascular disease, according to the Commonwealth Fund. Few plans are focused on mental health conditions, HIV, dementia or end-stage renal disease. 

  5. Special needs plans are more likely to offer nonmedical benefits than general MA plans, the Commonwealth Fund found. 

  6. As of February 2022, D-SNPs operated in 45 states and the District of Columbia, according to the Medicaid and CHIP Payment and Access Commission. 


  1. Enrollment in special needs plans has grown rapidly, tripling between 2010 and 2021, according to the Commonwealth Fund. 

  2. Special-needs plan enrollment has grown 17.3 percent since 2019, Chartis found, while enrollment in general Medicare Advantage has grown 8.3 percent in the same time. 

  3. The number of special needs plans is also increasing. For 2023, 1,270 special needs plans are available, up from 1,146 in 2022. 

  4. UnitedHealthcare has the largest share of special needs plans members, with 39.9 percent of the market. Humana accounts for another 15 percent of enrollees, according to Chartis. 

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