What You Should Know About Special Needs Plans (SNPs) & Medicare
Written by: Corey Whelan
Reviewed by: Shikita Nunnery, Licensed Insurance Agent
Medicare SNPs are a type of Medicare Advantage 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 Medicaid .
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
Medicare Special Needs Plans must also include prescription drug (Part D) coverage.
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)
SNPs are available as HMOs (health maintenance organizations) or PPOs (preferred provider organizations) to provide Medicare recipients with as many options as possible. Your costs and requirements may vary based on the type of plan you choose.
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.
Find a local Medicare plan that fits your needs
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
To be eligible, you must meet one of these criteria:
- 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.
If you are not currently living in a long-term care facility, the plan you choose must provide a CMS-approved needs assessment indicating you’ll need long-term care for 90 days or more.
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
- End-Stage Liver Disease
- End-Stage Renal Disease
- Hematologic Disorders
- Mental Health Conditions
- Neurologic Disorders
Are you eligible for cost-saving Medicare subsidies?
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:
- Deductibles, including the Medicare Part B deductible