Medicare Advantage Special Needs Plans for Dual Eligibles: A Primer

Abstract

The Special Needs Plan (SNP), a new type of Medicare Advantage plan created by the Medicare Modernization Act of 2003 (MMA), targets one of three special-needs populations—including beneficiaries who qualify both for Medicare and Medicaid benefits (“dual eligibles”), the focus of this issue brief. It identifies the key issues that underlie one of the MMA’s central goals for dualeligible SNPs—“the potential to offer the full array of Medicare and Medicaid benefits, and supplemental benefits, through a single plan”—and it outlines their progress thus far. The brief observes that true coordination between SNPs and Medicaid programs, despite some state and federal initiatives, has largely failed to occur, and it discusses some of the reasons why. Consequently, the brief offers recommendations for improving dual-eligible SNPs’ prospects and extending their lives (legal authorization for SNPs is scheduled to expire at year-end 2008).