WHY MEDICARE SPECIAL NEEDS PLANS (SNPs) ARE THE FASTEST GROWING SEGMENT FOR MEDICARE ADVANTAGE

Michael T. Braden September 10, 2026 MEDICARE PLANS

WHY MEDICARE SPECIAL NEEDS PLANS (SNPs) ARE THE FASTEST-GROWING SEGMENT FOR MEDICARE

Picture of Braden Medicare Insurance's Medicare Special Needs Plans Poster Offering Extra Care And Coverage To Those Who Qualify

Roughly 34 million Americans are enrolled in Medicare Advantage as of 2026, and the plans driving most of that growth are not the familiar HMOs or PPOs most people picture. Special Needs Plans, a distinct category within Medicare Part C, have expanded at a pace far outstripping the rest of the market. For people managing chronic conditions, limited incomes, or both Medicare and Medicaid, understanding this shift can help you understand your options.

WHAT ARE MEDICARE SPECIAL NEEDS PLANS?

A Special Needs Plan (SNP) provides benefits and services to people with specific severe and chronic diseases, certain health care needs, or who also have Medicaid.

SNPs include care coordination services and tailor their benefits, provider choices, and list of covered drugs (formularies) to meet best the specific needs of the groups they serve.

SNPs are either HMO or PPO plan types, and cover the same Medicare Part A and Part B benefits that all Medicare Advantage Plans cover. However, SNPs might also cover extra services for the special groups they serve. For example, if you have a severe condition, like cancer or congestive heart failure, and you need a hospital stay, an SNP may cover extra days in the hospital. You can only stay enrolled in an SNP if you continue to meet the special conditions of the plan.

CAN EVERYONE ENROLL IN A SNP?

You can join an SNP if you meet these requirements:

• You have Medicare  Part A (Hospital Insurance) & Medicare Part B (Medical Insurance)

• You live in the plan's Service Area.

• You meet the eligibility requirements for one of the 3 types of SNPs (or a subset of one of these groups) :

• Dual Eligible SNP (D-SNP)

• Chronic Condition SNP (C-SNP)

• Institutional SNP (I-SNP)

TAKING A CLOSER LOOK AT SPECIAL NEEDS PLANS GROWTH SINCE 2020

• Medicare Special Needs Plans have grown 2 to 3 times faster than overall Medicare Advantage enrollment over the past five years

• Dual Eligible Special Needs Plans (D-SNPs) make up roughly 70 to 75 percent of all SNP enrollment

• More than 1,000 SNP plans are offered nationally in 2026, with 16 to 18 percent of MA beneficiaries currently enrolled in a SNP.

• SNPs cover everything under Parts A and B plus Part D, with added benefits like dental, vision, hearing, transportation, and food allowances

ARE PRESCRIPTION DRUGS INCLUDED IN SNPs?

Yes, most SNPs include Part D prescription drug coverage, but covered drugs and cost tiers vary by plan, so check the formulary before enrolling. Provider networks also vary, so confirm that your doctors and specialists participate in a given SNP's network before switching.

WHY ARE MEDICARE SNPs SO POPULAR ALL OF A SUDDEN

The explosive growth of Special Needs Plans in the Medicare Advantage Category is primarily two-fold.

MONEY-REVENUE-PROFITS-MARKET SHARE

1.     Overall, Insurance Companies take on more risks for the care of patients with both Special Needs and Chronic Special Needs.  That means CMS pays them more than a regular Medicare Advantage Plan.  For those who didn't already know, Medicare pays Medicare Advantage Insurance Companies $1,000 per month for everyone enrolled in a Medicare Advantage plan.  This is the main source of revenue for Medicare Advantage plans, allowing them to offer additional perks and fuel their huge Advertising Budgets.

2.     Many aging Medicare Beneficiaries are single, either by choice or by the passing of their partner.  This makes money tighter, budgets smaller, and the need to pay less for more wherever it is possible.  Because Medicare Advantage SNPs are designed with a Whole Complete Care Approach, these plans are more desirable for seniors.  Additional benefits such as Healthy Grocery Allowance, Additional Transportation to Doctor Appointments, and Increased OTC Benefits are what Seniors are looking for.

3.     As the Medicare Population continues to rise due to the incredible amount of new Medicare Beneficiaries (10K people are turning 65 every day from now until the end of the decade). As these numbers increase, older age brings greater health challenges.  As new needs arise, it makes sense to provide the best care possible for any given condition.  And Medicare Advantage SNPs deliver better quality healthcare to Medicare Beneficiaries with both Special Needs and Chronic Special Needs than regular Medicare

MEDICARE BENEFICIARIES WHO QUALIFY FOR BOTH MEDICARE AND MEDICAID BENEFITS

Did you know that about 70-75% of all Medicare Special Needs Plan enrollees qualify for both Medicare and Medicaid?  Medicare refers to these individuals as Duals or Dual SNPs. As more people qualify for both Medicare and Medicaid Benefits as they age, this phenomenon creates a need for more detailed and specialized healthcare. Dual Eligibility Does Not Require D-SNP Enrollment.

Note: Just because a Medicare Beneficiary may qualify for both Medicare and Medicaid, they are free to enroll in any Medicare plan they want to.  So just because someone is a Dual Eligible Beneficiary does not mean they have to only enroll in a SNP or C-SNP plan. They can join any plan they want, and they can also return to Original Medicare. Specifically, Dual Special Needs Plans (D-SNPs) are modeled to combine Medicare and Medicaid coverage. Most D-SNP plans feature coordinated care management, unified appeals processes covering both programs, and supplemental benefits standard MA plans often skip, including dental care, vision, non-emergency medical transportation, and even food or grocery allowances.

WHAT BENEFITS ARE AVAILABLE TO SPECIAL NEEDS PLANS?

All Medicare Advantage plans, including SNPs, must cap your in-network out-of-pocket spending. In 2026, the Medicare Advantage maximum out-of-pocket limit for in-network services is $9,250. SNPs build supplemental benefits on top of this baseline protection; they do not replace it.

• HEALTH CLUB BENEFITS: Such as RENEW ACTIVE, SILVER & FIT and SILVER SNEAKERS, which cover gym memberships and fitness classes

• DENTAL BENEFITS: Are available with most plans.  These benefits are not nearly as comprehensive as they were 2-4 years ago.  Some plans cover only preventive care and simple fillings, while others may include coverage for Major work, including Dentures and/or Implants.  Check the EOC (Evidence of Coverage) for a detailed list of the benefits included in any plan you are considering. 

• ROUTINE VISION BENEFITS: Most plans offer routine Vision benefits, which include annual eye exams and prescription eyewear from extensive optometrist networks.

• ROUTINE HEARING BENEFITS: Vary from plan to plan.  Most plans will include an annual hearing test, and most provide some coverage for Hearing Aids, Hearing Amplifiers, etc.  If you or anyone you know may have VA Benefits, I highly recommend using the VA for Hearing devices.  They simply offer better-quality options than MA plans do.

• TRANSPORTATION BENEFITS: Most Medicare Advantage plans do not include Transportation to or from doctor's appointments.  However, most D-SNP and C-SNPs do cover Transportation.  Again, refer to the EOC for any plan to compare the exact transportation benefits it offers to and from medical appointments.

• OTC BENEFITS: Over-the-counter benefits are quarterly amounts you can use to purchase First Aid supplies, Vitamins, supplements, and OTC supplies such as personal hygiene products,

• HEALTHY GROCERY ALLOWANCES: This is a relatively new but growing supplemental benefit that gives plan members money they can use towards healthy and Organic foods each month.

QUESTIONS YOU SHOULD ASK BEFORE YOU ENROLL IN A MEDICARE SNP

Check CMS Star Ratings as a starting point, then go further. Ask whether the plan assigns a dedicated care manager, how it coordinates with your Medicaid coverage, and what the grievance and appeals process looks like if something goes wrong.

WHAT IS A MEDICARE SPECIAL NEEDS HEALTH PLAN?

A Special Needs Plan is a type of Medicare Advantage plan built for people in specific health situations, not for general enrollment. The three types are D-SNPs for dual-eligible individuals, C-SNPs for certain chronic conditions, and I-SNPs for people in institutional care. Qualifying does not mean you must enroll.

DO I AUTOMATICALLY QUALIFY TO ENROLL IN A D-SNP IF I HAVE MEDICARE AND MEDICAID?

Yes, having both Medicare and Medicaid makes you eligible to enroll in a dual eligible special needs plan during applicable enrollment periods. Eligibility is not an obligation, so you can compare D-SNPs against standard MA plans and Original Medicare before deciding.

WHY ARE THERE SO MANY MORE MEDICARE SNPs THAN THERE USED TO BE?

Insurers receive higher risk-adjusted payments from CMS for enrollees with complex needs, making SNP contracts financially attractive. That growth can benefit eligible enrollees through more choices and richer benefits, but it also means more comparison work before enrolling.

ARE MEDICARE SPECIAL NEEDS PLANS BETTER THAN REGULAR MEDICARE ADVANTAGE PLANS?

SNPs can offer stronger coordinated care and supplemental benefits for eligible people, but they are not designed for everyone. The right choice depends on your doctors, prescriptions, health conditions, and total cost, not just the plan category.

DO ALL SNPs HAVE AN OUT-OF-POCKET-MAXIMUM LIKE OTHER MEDICARE ADVANTAGE PLANS?

The 2026 in-network maximum out-of-pocket limit for Medicare Advantage plans, including SNPs, is $9,250. Some SNPs set a lower limit as a plan feature, giving extra financial protection to high-need enrollees who use frequent services.

CAN I SWITCH BACK TO A REGULAR MA OR MAPD PLAN IF I’M NOT HAPPY WITH THE SNP I ENROLLED IN?

Yes. You can switch plans during the Annual Enrollment Period from October 15 to December 7, or during the Medicare Advantage Open Enrollment Period from January 1 to March 31. Certain life events or eligibility changes may also trigger a Special Enrollment Period.

IS THE DRUG COVERAGE BETTER IN A SNP PLAN

Most SNPs include Part D prescription drug coverage, which helps people manage multiple chronic conditions. Most Part D formularies focus on common medications that similar SNP enrollees take.  Always check your medications against the plan's formulary before enrolling, since covered drugs and cost tiers vary by plan.

IF YOU QUALIFY FOR A SNP, IT IS DEFINITELY WORTH COMPARING ANY SNP OFFERED IN YOUR AREA VS REGULAR MA/MAPD PLANS

Special Needs plans, Dual Special Needs plans, and Chronic Special Needs plans are now the fastest-growing segment of all Medicare Advantage plans offered nationwide. This shapes the types of plans available in your area and how insurers design their offerings.

Whether a SNP fits your situation depends on your health needs, your doctors and medications, your budget, and the plans available where you live. There is no single correct answer, only a confident choice built on clear comparison rather than the lowest premium or the most familiar name.

WRAPPING THINGS UP

We hope you found our article on the growing popularity of Medicare Advantage Special Needs Plans, DSNPs, and C-SNPs informative and interesting. For many people, enrolling in a SNP offers more benefits and better overall coverage, and having a comprehensive Care Team available can reassure millions of Americans.

Medicare Special Needs Plans have many intricacies. At Braden Medicare Insurance, we strongly support every Medicare beneficiary working with a local, independent Medicare Broker or Certified Medicare Planner in your area.  There is no charge for their Medicare knowledge and experience.  You will always decide which plan/option is best for you. Let your Medicare Broker do the heavy lifting for you; that is what they do, 24/7. If you are not sure how to find a local independent Medicare Broker near you, Michael Braden, the owner of Braden Medicare Insurance Services, invites you to email him directly

at mike@bradenmedicare.com or call him directly at (480) 225-1393.

f you do not have a broker, please utilize the free  Medicare Plan Finder tool on the Medicare website at www.medicare.gov.

You can also call Medicare directly with questions at 1-800-MEDICARE (1-800-633-4227)—or visit the Medicare.gov website to start a live chat. TTY users should call 1-877-486-2048.