What Is a Medicare Special Needs Plan (SNP)?

Medicare Advantage plans called Special Needs Plans (SNP) are designed to provide customized care to people with specific health conditions.

A Special Needs Plan is a type of Medicare Advantage plan (also called Medicare Part C) that is designed specifically for someone with a particular disease or financial circumstance. The coverage offered by each SNP is built around providing more narrowly-focused care that better meets the needs of the patient. 

Read below to learn more about Special Needs Plans and to find out if this type of coverage may be right for you.

Man and nurse smiling in office

Who is covered by a Medicare SNP?

Medicare Advantage plans offer the same benefits covered by Medicare Part A and Part B combined into one plan sold by a private insurance company.

Medicare Advantage Special Needs Plans can also cater more specifically to the needs of people with: 

  • Dependence issues with alcohol or other substances
  • Autoimmune disorders
  • Cancer
  • Cardiovascular disorders
  • Chronic heart failure
  • Dementia
  • Diabetes mellitus
  • End-stage liver disease
  • End-Stage Renal Disease (ESRD) that requires dialysis
  • Severe hematologic disorders
  • HIV/AIDS
  • Chronic lung disorders
  • Strokes

There also Special Needs Plans that can be available to people who reside in a long-term care facility such as a skilled nursing home.

Some Medicare SNPs are designed for people who are dual-eligible, meaning they are eligible for both Medicare and Medicaid.

What the Medicare SNP coverage may include

Each Medicare SNP is designed to offer some unique benefits designed to serve the population for whom that plan is designed.

For example, a Medicare SNP for beneficiaries who have a chronic lung disorder may include: 

  • A network of providers who specialize in treating lung conditions
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  • Additional coverage for the type of prescription medications that are used to treat lung disorders
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  • A care coordinator who helps members stay on track with their appointments, medications, diet and exercise programs and more
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  • Clinical trials or certain types of alternative medicines and therapies 

In addition to the tailored benefits, Special Needs Plans provide all the same basic coverage as Original Medicare (Part A and Part B). A Medicare Advantage SNP may also offer benefits such as coverage for dental, hearing and vision care, as well as prescription drug coverage.

Medicare SNP eligibility

To be eligible for a Special Needs Plan, you must first be enrolled in Original Medicare and live in the area served by your desired plan.

The additional requirements for each type of SNP plan may also include: 

  • Chronic Condition SNP’s (C-SNP) – You must have a doctor’s note confirming you have the health condition addressed by the plan.
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  • Institutional SNP’s (I-SNP) – You must reside for at least 90 days in a long-term care facility that is served by the plan, or you must meet your state’s guidelines for needing nursing-level care at home for at least 90 days.
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  • Dual-Eligible SNP’s (D-SNP) – You must provide your Medicare and Medicaid enrollment verification. 

Medicare Open Enrollment Period

Enroll in a Medicare SNP

You may enroll in a Medicare SNP during the annual Medicare Open Enrollment Period that runs from October 15 to December 7 every year.

You may also enroll in a Medicare SNP if you are granted a Special Election Period. You may be given a Special Election Period if:

  • You already have Medicare and then develop a chronic health condition
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  • You move into a nursing home or other long-term care facility
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  • You move out of your current SNP coverage area
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  • Your SNP leaves the Medicare program
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  • You become eligible for Medicaid

Like other types of Medicare Advantage plans, Medicare SNPs will vary in terms of cost, coverage and availability from one location to the next.

You can call a licensed insurance agent at  TTY Users: 711 24 hours a day, 7 days a week to review and compare Medicare Special Needs Plans that may be available in your area. Find out if you are eligible, and find a plan that may be the right fit for your unique health care needs.

Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.