Special Needs Plans are growing explosively in Medicare Advantage, but understanding the operational risks is key.
About The Podcast:
Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.
Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.
Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.
Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.
Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.
Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.
About The Episode:
On this episode, Marc discusses the explosive growth of Special Needs Plans in Medicare Advantage. Health plans need to understand the operational risks as well as the opportunities.
Key Takeaways:
Plans have been investing heavily in SNPs for several years now and this occurred even with the financial woes many saw in 2024 that led to a massive retrenchment in terms of geographies, products, and benefits in 2025.
While individual MA plan offerings declined by 6.54% in 2025, SNP offerings increased 8.5% in 2025.
From January 2020 to September 2025, SNPs grew from 3.687M to 7.909M, a growth of 4.222M or 114.51%. About half of the growth noted above has come since January 2023.
Dual-Eligible or D-SNPs have dominated the numbers, capturing 3.351 of the 4.222 growth, or 79% of all growth. They grew 118% in the timeframe.
Chronic Care or C-SNPs grew the most from a percentage standpoint in the timeframe, growing by 1M or 271%.
Plans are investing due to the CMS Medicare-Medicaid integration strategy, synergies plans see between the two lines of business, and the potential for greater revenue and margin with SNPs.
But there are risks as well, including the current rate and risk adjustment environment, immature clinical oversight, greater integration, challenges with Star performance for dual eligibles, and the robust audit environment.
Program audits look at both SNP regulations and a plan’s Model of Care compliance as well.
Audits no longer limit their focus to health risk assessments and care plan issuance, but go deep into clinical practices, engagement of members with care teams, and how identified problems have been addressed.
CMS sees the increased use of technology as a dynamic and cost-effective way to identify problems and risks as well as undertake intervention strategies.
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Resources:
The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
