As MA expands deeper into higher-need populations, SNFs should anticipate growing clinical and social complexity among post-acute MA patients. For SNFs, this demographic shift means a growing share of MA post-acute patients will be dual-eligible or enrolled in Special Needs Plans, each carrying distinct care coordination requirements and reimbursement rules.
First-Time Medicare Advantage Enrollees Demonstrate Increasing Demographic and Clinical Diversity
Results showed a rise in the share of dually eligible beneficiaries (from 13.0% to 23.0%), low-income subsidy recipients (from 19.4% to 27.0%), Special Needs Plan enrollees (from 2.6% to 14.8%), and Black beneficiaries (from 12.7% to 18.3%) from 2012 to 2022. MA enrollees who became Medicare eligible due to disability comprised 31.7% of the sample. We observed a small but statistically significant mean annual increase in the RxRisk-V Comorbidity Index score (0.021; 95% CI, 0.020-0.022; P < .0001), translating to a mean increase of 2 diagnoses per 100 beneficiaries each year.
— The American Journal of Managed Care, March 10, 2026
Bozzi, Debra, et al. “First-Time Medicare Advantage Enrollees Demonstrate Increasing Demographic and Clinical Diversity.” The American Journal of Managed Care, 10 Mar. 2026. https://www.ajmc.com/view/first-time-medicare-advantage-enrollees-demonstrate-increasing-demographic-and-clinical-diversity.
How Diverse Is Medicare Advantage Enrollment? 4 Things to Know
The demographics and clinical statuses of Medicare Advantage enrollees have been getting more diverse over time, according to research published March 10 in the American Journal of Managed Care. The researchers reviewed enrollment files and pharmacy data spanning 2012 to 2022, looking at over 5 million first-time MA beneficiaries.
— Becker’s Payer Issues, March 11, 2026
✔ Comply with every payer's rules
✔ Equip your team with the Playbook
✔ Monitor rates and payer trends
