A Special Needs Plan is a type of Medicare Advantage plan available to beneficiaries with specific financial, health, or institutional needs. SNPs are regional and open to qualifying beneficiaries only.
Key Takeaways
- There are three types of Special Needs Plans: D-SNP (dual-eligible), C-SNP (chronic illness), and I-SNP (institutional).
- Medicare SNPs are Medicare Advantage plans.
- All SNPs provide prescription drug coverage.
- Beneficiaries must be enrolled in both Medicare Part A and Part B and qualify for the specific type of SNP.
- Qualifying beneficiaries can join an SNP during a Special Enrollment Period when they meet the plan’s required condition.
- Medicare SNP costs are plan-dependent, similar to Medicare Advantage costs.
How Do Medicare SNPs Work?
Medicare SNPs are Medicare Advantage plans, similar to an HMO. Medicare SNPs are restricted to individuals who meet the plan’s financial, chronic condition, or institutional requirements. Medicare SNPs are designed to provide benefits, provider options, and drug coverage specific to the beneficiary’s needs.1Medicare.gov, “Special Needs Plans (SNP)“, Accessed October 27, 2021
Medicare SNPs are also a type of coordinated care plan. This means a Medicare SNP care coordinator can organize treatment teams for the beneficiary’s special needs for chronic care services, any necessary institutional care, and which of the beneficiary’s insurances and programs cover the services if they are dual-eligible. This is so that treatment can be https://medicarewire.com/wp-content/uploads/2024/06/Geisinger-logo-1.svgistered for the SNP beneficiary as quickly as possible with minimal delay and error between teams.2Medicare.gov, “How Medicare Special Needs Plans (SNPs) work“, Accessed October 27, 2021
Are All Healthcare Providers Covered by an SNP?
Medicare SNPs are private health plans with their own provider networks. Beneficiaries are required to use the plan’s provider network for their care.1Medicare.gov, “Special Needs Plans (SNP)“, Accessed October 27, 2021
Do Medicare SNPs Cover Prescription Drugs?
All Medicare SNPs provide prescription drug coverage for their beneficiaries. SNPs tailor their list of covered drugs to suit the beneficiary’s health needs.1Medicare.gov, “Special Needs Plans (SNP)“, Accessed October 27, 2021
Who is Eligible for a Special Needs Plan?
In order to be eligible for a Medicare SNP, the beneficiary must be enrolled in Medicare Part A and Medicare Part B. The beneficiary must also check their region’s SNPs to see if their area has a plan meeting their special need. The beneficiary’s condition or situation must meet all eligibility requirements for the plan, which include the following:2Medicare.gov, “How Medicare Special Needs Plans (SNPs) work“, Accessed October 27, 2021
- Chronic Condition SNP (C-SNP): The beneficiary has one or more of these severe or disabling chronic conditions:
- Chronic alcohol and other dependence
- Autoimmune disorders
- Cancer (excluding pre-cancer conditions)
- Cardiovascular disorders
- Chronic heart failure
- Dementia
- Diabetes mellitus
- End-stage liver disease
-
End-Stage Renal Disease (ESRD) requiring dialysis (any mode of dialysis)
- Severe hematologic disorders
- HIV/AIDS
- Chronic lung disorders
- Chronic and disabling mental health conditions
- Neurologic disorders
- Stroke
- Institutional SNP (I-SNP): The beneficiary lives in an institution (like a nursing home) or requires nursing care at home.
- Dual Eligible SNP (D-SNP): The beneficiary has both Medicare and Medicaid.
How to Join a Medicare SNP
Qualifying beneficiaries can first join a Medicare SNP when they enroll in Medicare Part A and Part B during their Initial Enrollment Period. If a qualifying beneficiary is diagnosed with a severe health condition, or their situation changes as listed above, they can request a Special Enrollment Period to join a Medicare SNP. Beneficiaries can also join, drop, or change their Medicare SNP during the Medicare Annual Enrollment Period.3Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed October 27, 2021
The Costs of a Medicare SNP
Like most Medicare Advantage plans, the costs for Medicare SNPs are plan-dependent. The costs are similar to those of a Medicare Advantage plan, which are in addition to any Part A and Part B costs the beneficiary has. These costs include:4Medicare.gov, “Costs for Medicare Advantage Plans“, Accessed October 27, 2021
- Monthly premiums
- Annual deductibles
- Coinsurances and/or copayments
Dual-eligible beneficiaries with a D-SNP will have most of their SNP costs covered. D-SNP care coordinators can assist D-SNP members in accessing community resources and coordinating their various Medicare and Medicaid coverages to minimize most out-of-pocket costs.2Medicare.gov, “How Medicare Special Needs Plans (SNPs) work“, Accessed October 27, 2021
Citations
- 1Medicare.gov, “Special Needs Plans (SNP)“, Accessed October 27, 2021
- 2Medicare.gov, “How Medicare Special Needs Plans (SNPs) work“, Accessed October 27, 2021
- 3Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed October 27, 2021
- 4Medicare.gov, “Costs for Medicare Advantage Plans“, Accessed October 27, 2021