Trends Among Medicare Special Needs Plan Enrollment in Metropolitan and Nonmetropolitan Areas

Special Needs Plans (SNPs) are Medicare Advantage (MA) plans that provide benefits and services to people with specific conditions, health care needs, or who also have Medicaid. Established by the Medicare Modernization Act of 2003, the SNP program was initially set to expire in 2008, but the program has seen multiple extensions and been subject to a number of changes since that time. There are three SNP types for which beneficiaries are eligible based on meeting specific requirements: individuals living in a care facility (I-SNPs), individuals with dual enrollment in Medicare and Medicaid (D-SNPs), or individuals with a disabling chronic condition (C-SNPs). This brief examines recent trends in MA SNP enrollment by type and geographic variation across metropolitan and nonmetropolitan areas.

Key Findings:

• In 2025, there were 6.9M beneficiaries enrolled in SNPs while there were 34.4M beneficiaries enrolled in regular MA plans. Total MA enrollees (all plans) represent 55.4 percent of total Medicare beneficiaries.
• Overall, SNP enrollment increased by 276.8 percent from 2016 to 2025 (from 1.8M to 6.9M beneficiaries). The proportion of Medicare beneficiaries enrolled in a SNP grew from 3.6 percent in 2016 to 11.1 percent in 2025.
• Enrollment in all three SNP types grew fairly consistently between 2016 and 2025. D-SNPs have regularly had much higher enrollment than either C-SNPs or I-SNPs. However, there was a dramatic increase in C-SNP enrollment (73.1 percent) from 2024 to 2025.
• Nonmetropolitan areas experienced more dramatic growth in total SNP enrollment than metropolitan areas. Between 2016 and 2025, nonmetropolitan SNP enrollment grew from 0.2M to 1.1M beneficiaries (530 percent) while metropolitan SNP enrollment grew from 1.6M to 5.8M beneficiaries (250 percent). As a share of MA enrollees, SNP enrollment grew from 7.9 percent to 20.7 percent (a 164.6 percent increase) in nonmetropolitan areas vs growth of 10.7 percent to 20.0 percent (an 88.8 percent increase) in metropolitan areas.