Abstract
Enrollment, Health Care Use & Quality in Medicare Advantage Special Needs Plans for Older People with ADRD
Amanda C. Chen, PhD, Assistant Professor, University of Southern California
Authorized under the Medicare Modernization Act of 2003 and launched in 2006, Medicare Advantage (MA) Special Needs Plans (SNPs) are designed to address the needs of clinically complex populations. SNPs provide targeted care for specific eligible groups, including those who are dual-eligible for Medicare-Medicaid (D-SNPs), have a severe or disabling chronic condition (C-SNPs), or are institutionalized (I-SNPs). Although SNPs now account for 21% of the total MA market - with over 7 million beneficiaries enrolled in 2025 - it remains unclear whether these specialized plans effectively serve beneficiaries with Alzheimer's disease and related dementias (ADRD). While individuals with ADRD constitute a high-need population requiring well-coordinated, high-quality care, their complex needs may conflict with standard MA plan mechanisms designed to manage utilization and contain costs. This pilot study addresses gaps in the literature to-date by characterizing national enrollment trends and assesses whether the specialized nature of SNPs results in distinct patterns of health care use and quality for those with ADRD.