Medicare Advantage Special Needs Plans Just Surged 215% in 8 Years. Here Is What It Means for Nursing Homes.

Washington, D.C. — Enrollment in Medicare Advantage Special Needs Plans has exploded over the past eight years, growing 215% since 2018 while general Medicare Advantage plans grew just 49% over the same period. The surge is reshaping how high-need beneficiaries access care — and nursing homes are squarely in the middle of it.

According to new data from the Centers for Medicare & Medicaid Services, more than 8 million people are now enrolled in Special Needs Plans as of February 2026. That is an increase of nearly 900,000 enrollees in just one year. SNPs now account for roughly 23% of all Medicare Advantage enrollment, up from 21% in 2025 and just 13% in 2018.

What Makes Special Needs Plans Different

Unlike standard Medicare Advantage plans, SNPs restrict enrollment to beneficiaries with specific health or demographic profiles. There are three main types: Chronic Condition Special Needs Plans for people with severe or disabling conditions like diabetes or heart failure; Dual-Eligible Special Needs Plans for those who qualify for both Medicare and Medicaid; and Institutional Special Needs Plans, or I-SNPs, designed specifically for residents of nursing homes and other long-term care facilities.

Industry reports show SNP members carry substantially higher risk scores than general Medicare Advantage enrollees — averaging 51% higher. They experience more chronic illness, greater functional impairment, and higher rates of frailty and activities-of-daily-living needs. That concentration of complex cases means SNPs operate under stricter federal requirements and invest heavily in care coordination.

Why the Growth Matters for Nursing Homes

The expansion of SNPs carries direct implications for skilled nursing operators. For facilities with I-SNP contracts, the growth represents a deepening pool of covered residents whose care is managed through specialized plans designed around institutional settings. These plans typically deploy on-site clinical teams and align financial incentives to reduce hospitalizations — a key metric for nursing home operators navigating prior authorization changes across the Medicare Advantage landscape.

On the D-SNP side, the growth is concentrated in exclusively aligned enrollment products that integrate Medicare and Medicaid benefits. With federal and state policy pushing toward tighter Medicare-Medicaid integration by 2027 and 2030, the enrollment data suggests both plans and states are positioning for what is coming.

The Carrier Shuffle

The growth is not spread evenly. Among the five largest Medicare Advantage insurers, only Humana and Kaiser Permanente posted enrollment gains in 2026. Humana added 1.2 million enrollees across all plan types, while Kaiser picked up 64,000. UnitedHealth Group, the largest Medicare Advantage insurer, lost more than 530,000 enrollees year-over-year — though it did gain 267,000 SNP members, suggesting a strategic pivot toward the high-need segment even as its broader book shrank.

Smaller insurers with fewer than 1 million enrollees collectively added 734,000 people in 2026, with more than three-quarters of them seeing enrollment increases.

Looking Ahead

For nursing homes, the SNP surge points toward a future where an increasing share of residents arrive through specialized managed care arrangements rather than traditional Medicare. That shift brings both opportunity — dedicated care coordination resources, aligned incentives — and complexity, as operators navigate varying plan requirements, documentation demands, and reimbursement structures.

CMS has signaled it is watching the SNP expansion closely. The agency is currently gathering information through requests for comment and expert discussions to inform future policymaking on how these plans fit into the broader Medicare landscape.

With SNPs now covering nearly one in four Medicare Advantage beneficiaries, the question for nursing homes is no longer whether to engage with these plans — it is how to do it effectively.