Number of I-SNP Plans Goes Up Almost 30% Year-Over-Year

The number of skilled nursing providers interested in becoming insurers has grown for the past several months. Now hard numbers show just how great that interest is.

Special needs plans are a category within Medicare Advantage (MA) that provide a common framework for the plans that serve special-needs beneficiaries, while also expanding beneficiary choice and access among MA plans.

New data from the Medicare Payment Advisory Commission (MedPAC) give a sense of how much that provider interest has borne fruit. From April 2018 to April 2019, the number of institutional special needs plans (I-SNPs) – which enroll only beneficiaries who reside in institutions or who are nursing-home certified – grew by 29%, going from 97 to 125.


Enrollment in I-SNPs, which started increasing beginning in 2016, rose from 74,000 in 2018 to 87,000 in 2019.

Chart showing the number of Special Needs Plans and Special Needs Plan Enrollment from April 2018 to April 2019
Source: MedPAC

For SNFs, the I-SNP attraction lies in the ability to take control of the financial future by taking on more health care risk, according to an analysis from Anne Tumlinson and Elizabeth Walsh of Anne Tumlinson Innovations. That analysis, from December of last year, found that long-term care providers are driving the growth in the number of MA special needs plans.

“The provider-owned I-SNP gives nursing home operators direct Medicare funding – through the premium — to finance robust onsite primary care and care coordination for the long-stay resident population,” Tumlinson and Walsh wrote. “It also rewards providers for the avoidance of long-stay resident hospitalizations whereas perverse incentives in the FFS system reward facilities that hospitalize long-stay residents.”


Special needs plans were permanently enacted by the Bipartisan Budget Act of 2018, and that permanence may have increased their attraction to providers, Jennifer Boese, the director of health care policy at the accounting and advisory firm CLA, said during a recent SNN webinar.

“If I’m going to invest in all the capabilities and the financial and the capital of [becoming] a Medicare Advantage plan, a SNP — which means I’m going to become an insurer — I’m probably going to want to make sure that that opportunity is not going to go away,” Boese said. “Up until last year, there was arguably the possibility for SNPs to go away. But now it is not so.”

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