How Specialized Are Special Needs Plans? Evidence From Provider Networks

Abstract

Enrollment in Medicare Advantage (MA) Dual-Eligible Special Needs Plans (D-SNPs) among individuals dually eligible for Medicare and Medicaid has more than tripled over the past decade. Little is known about whether D-SNP plan design differs from standard MA plan design nor whether this design reflects the needs of dual-eligible enrollees. We characterize the degree to which D-SNPs specialize in an important plan design dimension—provider networks. We find that in 2022, 46% of D-SNPs offer networks that are distinct from the insurer’s standard MA plan networks. Compared with D-SNP networks that are shared with standard MA plans, specialized D-SNP networks include more psychiatrists, Ob/Gyn’s, and neurologists, providers that specialize in treating conditions more common among dually eligible enrollees. Network specialization is more common among insurers participating in the local Medicaid market and less common in provider shortage areas, suggesting investment in Medicaid and reduced provider negotiation costs may facilitate specialization.

Keywords

Medicare Advantage D-SNPs provider networks Medicaid

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