What You Should Know About Special Needs Plans (SNPs) & Medicare
Key Takeaways
- Medicare SNPs are a type of Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plan that limits membership to people with a characteristic or condition in common.
- There are SNPs designed to meet the financial and medical needs of eligible people who get Medicare and MedicaidMedicaid is a state-based health insurance program for individuals that qualify. Unlike Medicare, Medicaid does not have age restrictions for members. .
- There are also plans for people with chronic and severe health conditions and those who need long-term institutionalized care.
What Does SNP Mean?
If you’re eligible for Medicare, you may have the option to enroll in a Special Needs Plan (SNP). So what does SNP stand for? In Medicare, SNP stands for Special Needs Plan.
What is SNP? Medicare Special Needs Plans (SNPs) are a Medicare Advantage (Part C) coordinated care plan you purchase directly from a private insurer, or with the help of a licensed insurance agent such as GoHealth.
Unlike other Part C plans, SNPs limit membership to people who have a characteristic or condition in common. This helps SNPs ensure each plan is tailored to specific medical or financial needs.
SNPs cover everything Original Medicare (Part A and Part B) does, under one plan’s umbrella. Some services you can expect coverage for include:
- Inpatient hospital care
- Home health services
- Physical and occupational therapy
- Durable medical equipment
- Preventive medical care
- Clinical research
- Ambulance services
SNPs gear their provider networks, drug formularies, and benefits to the population they serve. They typically cover extras you may find beneficial. These can include having a care coordinator who oversees your treatment and extended hospital stays, if needed. Other extras may include:
- Hearing aids
- Dental care
- Vision care
- Gym membership (SilverSneakers)
It is up to each insurer to decide which plans they will offer within specific counties and states. For that reason, not every type of SNP plan is available everywhere.
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How Do You Qualify For SNP?
To qualify for a SNP, you must have Medicare.
In addition, you must meet specific requirements and be able to show proof of meeting these requirements, as needed. However, if you do qualify, you can join a SNP plan at any time. Each type of SNP has different eligibility rules for membership:
Dual Eligible SNP (D-SNP): This type of SNP is for people who have Medicaid and Medicare. To qualify, you need a Medicaid card or a letter indicating your enrollment status in Medicaid.
Since Medicaid is a state-administered program, your eligibility requirements may vary from state to state. Typically, Medicaid requirements are based upon financial need. In addition, having specific disabilities, such as blindness, may also make you eligible for Medicaid.
Chronic Condition SNP (C-SNP): These SNPs are for specific people with severe or disabling chronic conditions. A SNP may limit eligibility to people with one or several health conditions, provided the conditions are clinically linked. For example, a plan may restrict membership to people who have either or both diabetes and chronic heart failure.
There are many diseases and disorders which may make you eligible for a C-SNP. To qualify for this type of program, you will need documentation from a physician stating that you have a health condition that appears on Medicare’s approved list. The list appears further down in this article.
Institutional SNP (I-SNP): I-SNPs are for people who need or will need the level of care given in a long-term care facility (90 days or more). These facilities include:
- Skilled nursing facility
- Long term care nursing facility
- Inpatient psychiatric facility
- Intermediate care facility for people with intellectual disabilities
- You already reside in a long-term care facility, such as a group home.
- You don’t as of yet reside in a long-term care facility, but you do meet your state’s guidelines for needing this level of care, with no apparent end date in sight.
What Are the 3 Types of Special Needs Plans?
There are three distinct types of SNPs. Each one addresses specific health or financial concern and aims to provide Medicare-eligible people with optimum care and support.
The three SNPs are:
- Chronic Condition SNP (C-SNP)
- Dual Eligible SNP (D-SNP)
- Institutional SNP (I-SNP)
What chronic conditions qualify for a SNP?
Fifteen different chronic condition categories may qualify you for an SNP. For example, if you are eligible for Medicare (or Medicaid) and have a chronic condition, you may qualify for a C-SNP:
- Autoimmune Disorders
- Cardiovascular Disorders
- Chronic Heart Failure
- Chronic Lung Disorders
- Chronic Substance or Alcohol Use
- Dementia
- Diabetes
- Cancer
- HIV/AIDS
- Stroke
- End-Stage Liver Disease
- End-Stage Renal Disease
- Hematologic Disorders
- Mental Health Conditions
- Neurologic Disorders
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What is a Medicare Dual Special Needs Plan?
A Medicare Dual Special Needs plan is simply an abbreviated way of referring to a Medicare Dual Eligible Special Needs Plan (D-SNP). D-SNPs are for people already enrolled in both Medicare and Medicaid. D-SNPs provide comprehensive health coverage that combines the benefits of Medicare and Medicaid in one plan.
So, how does it work? A D-SNP is an all-in-one plan that combines your Medicaid with your Medicare Part A and Part B benefits and Medicare Part D prescription drug coverage. In addition, if you enroll in a D-SNP, you are eligible for other services and additional health coverage, like vision and dental.
If you think about the SNP meaning, how is D-SNP different? D-SNPs help people with financial needs get high-quality healthcare without having to worry about costs. D-SNPs eliminate many out-of-pocket costs that Medicare beneficiaries typically have to pay. These include:
- Coinsurance
- Deductibles, including the Medicare Part B deductible
- Copays
Sources
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.