Your Complete Guide to Medicare Special Needs Plans (SNP)

A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage plan (Medicare Part C) that is designed to fit the health care needs of people with a certain health condition or circumstance.

Medicare SNP benefits, provider choices and drug formularies are all designed specifically to serve a beneficiary who meets the specific criteria of that plan.

What Are Medicare Special Needs Plans?

Special Needs Plans are a type of Medicare Advantage plan.

Medicare Advantage plans are a form of private Medicare coverage. These plans, sold by private insurance companies, offer all the same benefits as Original Medicare (Part A and Part B).

Many Medicare Advantage plans also offer some additional coverage, which may include coverage for dental, vision, hearing, prescription drugs and more.

What Are the 3 Types of Special Needs Plans?

• Dual-eligible Special Needs Plans (D-SNP)
  These plans are designed for people who are “dual-eligible,” or eligible for both Medicare and Medicaid.
  
  
• Institutional Special Needs Plans (I-SNP)
  These plans are for people who are institutionalized in a nursing home or require nursing care at home.
  
  
• Chronic Condition Special Needs Plans (C-SNP)
  There are 15 different health conditions that may have a corresponding Medicare Special Needs Plan:
  • Chronic alcohol and drug dependence
  • Certain autoimmune disorders
  • Cancer (excluding pre-cancer conditions or in-situ status)
  • Certain cardiovascular disorders
  • Chronic heart failure
  • Dementia
  • Diabetes mellitus
  • End-stage liver disease
  • End-stage renal disease requiring dialysis
  • Certain severe hematologic disorders
  • HIV/AIDS
  • Chronic lung disorders
  • Chronic and disabling mental health conditions
  • Neurologic disorders
  • Stroke

Keep in mind, Special Needs Plans may not be available where you live.

Who Qualifies For Medicare Special Needs Plans?

In order to qualify for a Special Needs Plan, you must meet each of the following criteria:

• Be enrolled in Medicare Part A and Part B
• Have one of the chronic conditions above, reside in a nursing home or require home nursing care or be Medicare dual-eligible
• Reside in the plan’s service area

A Chronic Condition SNP will require a note from your doctor confirming your diagnosis.

An Institutional SNP requires residence in a long-term care facility for at least 90 days or home nursing care for 90 days or more.   

Special Needs Plans are sold by private insurance companies, so plan selection may vary from one location and carrier to the next.

As of May 2019, there are a total of 734 Special Needs Plans available throughout the U.S.¹ The breakdown of those plans is as follows:

• 480 D-SNPs
• 129 C-SNPs
• 125 I-SNPs

Availability depends on where you live. Not all states or areas have SNP plans.

What Do Special Needs Plans Cost?

If you are Medicare dual-eligible, some of the costs to join a D-SNP (such as premiums and deductibles) may be covered for you.

For other Special Needs Plans, your costs might vary but may include a monthly premium, deductible and coinsurance or copayments.

What Are Care Coordinators?

Some Medicare Special Needs Plans utilize a “care coordinator.”

A care coordinator is a type of personal health care assistant who helps you schedule appointments, adhere to your doctor-recommended diet and exercise plan, obtain the right prescriptions, access community resources and more.

Will My Doctor Accept My Medicare Special Needs Plan?

Most Special Needs Plans will require you to have a primary care physician (PCP) who must issue you a referral before seeing a specialist.

Typically, you must remain in the plan’s network of providers to receive care, except in the case of emergency or urgent care, or for those with End-Stage Renal Disease (ESRD) seeking out-of-area dialysis.

What Do Medicare SNPs Cover?

Like all Medicare Advantage plans, Special Needs Plans will provide all of the same coverage as Medicare Part A and Part B.

Additionally, Special Needs Plans may feature a custom set of benefits designed specifically for the needs of the beneficiary.

All Medicare Special Needs Plans include prescription drug coverage.

How Do I Enroll in a Medicare Special Needs Plan?

You may join a Medicare Special Needs Plan during the same enrollment periods used for standard Medicare Advantage plans.

These enrollment periods include:

• Initial Enrollment Period (IEP)
  Your Medicare IEP is a seven-month period that begins three months before you turn 65 years old, includes the month of your birthday and extends for three more months thereafter.
  
  
• Annual Enrollment Period (AEP)
  The Medicare AEP takes place every year from October 15 to December 7.
  
  
• Special Enrollment Period (SEP)
  You may be granted a Special Enrollment Period at any time throughout the year, depending on your circumstances.
  
  You may potentially qualify for an SEP if you go through a qualifying event, such as moving to a new service area, losing employer coverage, being released from a long-term care facility and more.
  
  The length of your Special Enrollment Period and the effective date of coverage changes you make may vary depending on your qualifying circumstances.

You can learn more about Medicare Special Needs Plans by visiting MedicareAdvantage.com.

¹ CMS. SNP Comprehensive Report (PDF). Retrieved June, 2019, from www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData/Special-Needs-Plan-SNP-Data-Items/SNP-Comprehensive-Report-2019-05.html.

Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.