Medicare Advantage Plans establish SNPs to provide care to dualeligibles, high-risk patients

May 1, 2006

Under a new medicare program to expand coordinated care forvulnerable seniors, insurers and managed care plans across thecountry are offering a range of Special Needs Plans (SNPs, or"snips") to beneficiaries who are dual eligibles, in nursing homesor suffer from chronic conditions. Most of the 275 SNPs approved bythe Medicare program so far aim to provide care to low-incomeseniors who now receive prescription drug benefits from Medicareinstead of state Medicaid programs; special needs plans for othergroups are emerging slowly.

Under a new medicare program to expand coordinated care for vulnerable seniors, insurers and managed care plans across the country are offering a range of Special Needs Plans (SNPs, or "snips") to beneficiaries who are dual eligibles, in nursing homes or suffer from chronic conditions. Most of the 275 SNPs approved by the Medicare program so far aim to provide care to low-income seniors who now receive prescription drug benefits from Medicare instead of state Medicaid programs; special needs plans for other groups are emerging slowly.

For the Centers for Medicare and Medicaid Services (CMS), the program provides an opportunity to better coordinate federal and state coverage for vulnerable populations. The hope is that SNPs will be able to provide higher quality of care to these patients at lower costs.

RAPID GROWTH

As a result, almost 60% of all Medicare beneficiaries now live in areas served by some kind of SNP. Most are clustered in more populated regions, while eight states have only one SNP. Florida has 14 SNP contracts, followed by New York, Minnesota, California, Arizona and Texas. Although only 65,000 Medicare beneficiaries were enrolled in SNPs last year, the number now is much higher and is projected to grow as additional SNPs gain approval.

The market response "is much stronger than anyone anticipated when the measure was drafted," says John Blum, analyst with Avalere Health. The Medicare legislation aimed to provide an umbrella for several smaller demonstrations and other special programs. Insurers have seized the program as a way to broaden their market by integrating services for dual eligibles, as well as for institutionalized and vulnerable populations, Blum says. And some plans are offering "niche products" that provide services to seniors with HIV/AIDS or mental health conditions.