- A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage plan for individuals with extra healthcare needs.
- Medicare SNPs include Medicare Part D prescription drug coverage.
- Depending on the type of SNP you choose, your plan may include additional medical services.
- You must be able to prove that you qualify for a Medicare SNP based on a medical diagnosis or level of income.
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 coverage to those who need it most. Read on to learn about Medicare SNPs and how they may be able to help you.
Medicare SNPs are a type of Medicare Advantage (Part C) plan that was created by Congress to help people with specific types of healthcare needs.
What is covered by a Medicare SNP?
Under this type of plan, you have coverage for your doctor’s visits, hospital stays, medications, and other services that you may need to manage your health.
The main difference between SNPs and other Medicare Advantage options is that SNPs offer extra services based on your unique healthcare needs. This may include an allowance for extra days in the hospital, a care management specialist, or other social services.
What types of SNPs are there?
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 for people who have severe or disabling chronic conditions. If you have one of the following conditions, you may be eligible for this type of plan:
- chronic heart failure
- type 2 diabetes
- end stage liver disease
- end stage renal disease (ESRD)
- substance use disorder
This category also covers several groups of chronic diseases, including:
- autoimmune disorders
- cardiovascular disease
- hematologic (blood) disorders
- lung disease
- mental health conditions
- neurological issues
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)
As of 2019, about 11 million Americans are eligible for both federal (Medicare) and state (Medicaid) healthcare plans. People in this group have special healthcare needs, due to both their medical or mental health needs and their ability or inability to pay for their care.
As with any healthcare plan, there are specific advantages and disadvantages of SNPs to consider before enrolling.
Advantages of SNPs
There are many advantages of enrolling in an SNP, since it’s designed to help with your specific needs. Some of the benefits include:
- Care coordination. You’ll have a care coordinator who may be your primary care physician or a healthcare team that will oversee your medical care. By working together, they will make sure you are receiving all of the treatments you need to manage your condition(s).
- Prescription drug coverage. Since drug coverage in included in the plan, you won’t need to shop for a separate Part D plan.
- Additional coverage. As with most Medicare Advantage plans, you’ll received extra coverage not offered by original Medicare. These often include vision, hearing, dental, and fitness services.
- Low cost. The costs for these plans are usually pretty reasonable, especially if you qualify based on a low income. There are also limits on out-of-pocket costs, which is something original Medicare does not have.
Disadvantages of SNPs
However, there are also some potential downsides to consider as well, including:
- Availability. Not all types of SNPs are available in all areas. Additionally, you may have limited coverage options if you need care when you’re traveling outside of the state where you live.
- Limited provider options. With SNPs, you’ll have to stick with a network of providers that is decided by the insurance company that offers your plan. This could mean that your preferred doctor might not be covered if they are outside of the plan’s network.
- Referrals. You’ll also need to get a referral from your primary care physician if you need to see a specialist. Some plans may also require you to get preapproval from the insurance company beforehand.
Different plans offer different premium costs, and copays may vary from plan to plan. Before enrolling in an SNP, review the company’s plan materials and ask about out-of-pocket costs and limits you may expect to pay. SNPs cannot charge more than they do for other Medicare-approved 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.
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.
Next, we’ll go over the basics of what you’ll need in order to qualify for each type of SNP.
- 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.
When you can enroll
Automatic enrollment doesn’t occur with SNPs, and typically you would join a SNP during set Medicare Advantage enrollment periods.
Special enrollment periods are also offered for a number of reasons, including a change in your health conditions, employment status, where you live, or the plan you have.
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.
Who is eligible for Medicare SNPs?
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.
Apart from that, you’ll need to qualify for a specific type of SNP based on the rules of that plan, such as having a medical diagnosis or certain level of income.
- 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 your expenses.
- Medicare has specific enrollment periods, but the factors that make you eligible for an SNP often make you eligible for special enrollment periods, too.