• A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage plan for individuals with extra healthcare needs who are already enrolled in Medicare parts A, B, and C.
  • Medicare SNPs include Medicare Part D prescription drug coverage.
  • Depending on the type of SNP you choose, your plan may include additional medical services such as extra days in the hospital, care management, or special social services.
  • You must be able to prove that you qualify for a Medicare SNP based on your diagnosis.
  • Medicare SNPs are not available in all areas.

Public insurance programs can be difficult to understand, and Medicare is no exception. For people with extensive medical issues or other special needs, the challenge only increases, but there is help.

Medicare Special Needs Plans (SNPs) offer additional Medicare coverage to those who need it most. Read on to learn about Medicare SNPs and how they may help you.

Medicare SNPs are a type of Medicare Advantage plan created by Congress in 2003 to help individuals with extra healthcare needs.

These plans are available to people who already have Medicare Part C, the Medicare part that combines coverage of both Medicare Part A and Medicare Part B. SNPs also include Medicare Part D, which covers approved prescription drug costs.

All these letters can get overwhelming quickly, especially when you have special circumstances and health problems to deal with. A Medicare SNP includes all these services under one program, offering hospitalization (Part A), medical services (Part B), and prescription drug coverage (Part D) in one plan.

Under this plan, you have coverage for your doctor’s visits, hospital stays, medications, and other services that you may need to stay healthy. The main difference between Special Needs Plans and other Medicare Advantage options is that SNPs offer extra services based on your unique healthcare needs, including extra days in the hospital, care management, or special social services.

types of Medicare SNps

There are three types of Medicare SNPs:

  • Chronic Condition Special Needs plans (C-SNPs) for people with chronic health conditions
  • Institutional Special Needs plans (I-SNPs) for people who live in nursing homes or long-term care facilities
  • Dual Eligible SNPs (D-SNPs) for patients who are eligible for both Medicare and Medicaid coverage.

These plans each offer comprehensive hospitalization, medical service, and prescription coverage, but have been separated based on the kinds of patients they serve.

SNPs are broken into the following groups based on specific health needs. Here are the details of these plans.

Chronic Condition Special Needs plans (C-SNPs)

C-SNPs are aimed at people who have severe or disabling chronic conditions. Two-thirds of people who use Medicare may meet these criteria, and this plan helps provide the complex care they need.

You must have certain conditions to use this plan, which include:

This category also covers several groups of chronic diseases, including:

Institutional Special Needs plans (I-SNPs)

I-SNPs are used for people who need to live in some form of medical institution for 90 days or more. These include long-term care facilities, skilled nursing facilities, long-term care nursing centers, intermediate care centers for people with intellectual disabilities, or resident psychiatric facilities.

Dual Eligible SNPs (D-SNPs)

D-SNPs are perhaps the most complex. They offer additional coverage to the people who are eligible for both Medicare and Medicaid.

About 11 million Americans are eligible for both federal (Medicare) and state (Medicaid) healthcare plans, and they tend to have the greatest healthcare needs, due to both their medical or mental health needs and their ability or inability to pay for their care.

To be eligible for a Special Needs Plan, you must qualify for a C-SNP, I-SNP, or D-SNP, and you must already be enrolled in both Medicare parts A and B, or a combination also known as Part C.

SNPs are operated by health insurance companies contracted by the government, and each provider may offer a slightly different program. Some of these may be Health Maintenance Organizations (HMO) or Preferred Provider Organizations (PPO).

Not all SNPs are the same, and they are not offered in every state. In 2016, D-SNPs were offered in 39 states and Puerto Rico.

Different plans under the Special Needs Program may have different costs. Under the Special Needs Program, you will keep paying your Medicare Part B premium, but some plans may charge extra on top of that.

If you think you qualify for an SNP, you can call Medicare (1-800-633-4227) to apply and prove that you are eligible.

C-SNP

If you are applying under the chronic disease program, you will have to provide a note from your doctor stating that you have one of the covered conditions.

I-SNP

For the institutional plan, you must live for at least 90 days in a long-term care facility covered by the program, or meet your state’s requirements for needing higher level care like nursing home services.

D-SNP

For the dual eligibility plan, you will have to prove that you have Medicaid by showing a card or letter from Medicaid. Automatic enrollment doesn’t occur with SNPs, and typically you would join a SNP during set Medicare Advantage enrollment periods.

Special enrollment periods

Special enrollment periods are offered for a number of reasons in all Medicare Advantage plans, including a change in your health conditions, employment status, where you live, or the plan you have.

For the Special Needs Program, there are even more special enrollment considerations. Special enrollment is offered to anyone with both Medicare and Medicaid as long as you are enrolled in both programs. People who need to move to a higher level of care or into a nursing home, and those with disabling chronic illness, can enroll in an SNP at any time.

important dates for medicare enrollment

Here are some important dates to remember for Medicare enrollment:

  • When you turn 65. You have 3 months before your birth month and 3 months after to sign up for initial Medicare coverage.
  • Medicare Advantage enrollment (January 1 to March 31). During this period, you may enroll in Medicare Advantage or change your Advantage plan.
  • General Medicare enrollment period (January 1 to March 31). If you didn’t sign up during the initial period, you may enroll during general enrollment if you don’t quality for special enrollment.
  • Open enrollment (October 15 to December 7). This is a time to sign up for Medicare if you haven’t already, or you may change or leave your current plan.
  • Special enrollment. This is available at any time, as long as you meet the criteria for enrolling in a new or different plan, such as if your plan is dropped, you move to a new location, you become eligible for both Medicare and Medicaid, or other qualifying reasons.

Different plans offer different Special Needs Program premium costs, and copays may vary from plan to plan. Before enrolling in an SNP, review the insurance company materials about the plan and ask the provider about out-of-pocket costs and limits you may expect to pay. Providers of SNPs cannot charge more than they do for other Medicare plans for many services.

help covering the cost of medicare

Medicare offers programs to help cover your healthcare costs, and you may qualify for Medicare’s Extra Help Program to help with your out-of-pocket prescription drug costs.

For help with Medicare SNPs contact:

If you have Medicaid, the cost to join a Medicare plan will be paid for you. If you have Medicare alone, the SNP costs should be close to what you already pay under a Medicare Advantage plan.

  • Medicare SNPs combine Medicare parts A, B, and D to provide comprehensive care with extra medical and social services.
  • Costs vary by plans, but premium assistance can help lower the burden.
  • Medicare has specific enrollment periods, but the factors that make you eligible for a Special Needs Plan often make you eligible for special enrollment periods, too.