What is a Medicare SNP?
A Special Needs Plan (SNP) is a type of Medicare Advantage plan that’s available to beneficiaries with specific financial, health, or institutional needs. SNPs are regional, not available in all areas, and open to qualifying beneficiaries only.
Key Takeaways
- There are three types of Special Needs Plans: D-SNP (dual-eligibleDual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program....), C-SNP (chronic illness), and I-SNP (institutional).
- Medicare SNPs are Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B).....
- All SNPs provide prescription drug coverage.
- Beneficiaries must be enrolled in both Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care.... and Part B and qualify for the specific type of SNP.
- Qualifying beneficiaries can join an SNP during a Special Enrollment PeriodSpecial Enrollment Periods (SEPs) allow beneficiaries to change their Medicare Advantage and Part D plans due to a special circumstance. Common reasons for a SEP include moving, losing employer coverage, and Medicaid eligibility, to name... 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 needs of the beneficiaryA person who has health care insurance through the Medicare or Medicaid programs.....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 administered 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 BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare.... 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 MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States.....
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 PeriodThe Initial Enrollment Period is a seven-month period when new beneficiaries can enroll in Medicare without a penalty. Most people enroll in Medicare at age 65..... 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 PeriodThe Annual Enrollment Period is when Medicare beneficiaries can join, drop or change Medicare Advantage and Medicare Part D prescription drug plans. AEP begins on 15 October and ends on 7 December.....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 premiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. ...
- Annual deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share....
- Coinsurances and/or copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service....
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 costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments.....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