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.

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Who is covered by a Medicare SNP?

A Special Needs Plan can work similarly to other types of Medicare Advantage plans.

Medicare Advantage plans offer an alternative way to receive Original Medicare benefits (Part A and Part B), and many Medicare Advantage plans offer additional benefits that aren't covered by Original Medicare.

Medicare Advantage plans come in a variety of types such as HMOs and PPOs. While Original Medicare can be used all over the country, most Medicare Special Needs Plans feature a network of participating health care providers, pharmacists and suppliers where the plan may be used.

Who is covered by a Medicare SNP?

As mentioned above, 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 does a Medicare SNP cover?

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. A Medicare Advantage SNP may also offer benefits such as coverage for dental, hearing and vision care, as well as prescription drug coverage.

What are the benefits of a Special Needs Plan?

Special Needs Plans can be particularly beneficial because of their focused coverage benefits. 

  • Care coordination
    Some Special Needs Plans feature care coordination services. These plans may assign a care coordinator to each member who serves as a sort of "quarterback" for your care.

    Your care coordinator can help you better understand your condition, monitor your treatment regimen to help you stay on track and consult with specialists within the plan network to steer you toward the care you need.

    A care coordinator may also set you up with wellness programs, lifestyle activities or a special diet to help you manage your condition.

  • Specialized networks and drug formularies
    Most Medicare Advantage plans feature a network of participating providers.

    SNP network providers are typically specialists who focus their care on the very type of condition, symptoms and treatment associated with your situation. The right type of care can be hard to find, and Special Needs Plans can help you find the specialized providers you need.

    Medicare Special Needs Plans also generally feature a list of covered prescription drugs that are commonly used to treat your specific condition.

    While most Medicare Advantage plans include prescription drug coverage, all Special Needs Plans are required to include this benefit.

  • Coverage for ESRD
    People with End-Stage Renal Disease (ESRD, kidney failure requiring dialysis) may not typically qualify for a traditional Medicare Advantage plan, even though they qualify for Original Medicare.

    However, depending on where you live, there may be Special Needs Plans designed specifically for people with ESRD that are available in your area. 

Am I eligible for a Medicare Special Needs Plan?

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 AEP graphic

When can I 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.

How much does a Special Needs Plan cost?

Depending on the plan you have, a Special Needs Plan may include some of the following costs:

  • Monthly premium
  • Deductible
  • Copayments or coinsurance
  • Additional premiums or deductibles for prescription drug coverage (if required by the plan)

The costs tied to Special Needs Plans can vary significantly between one area, plan or insurance carrier to the next. Costs can also depend on whether or not you qualify for financial assistance or are eligible for Medicaid.

How do I enroll in a Medicare SNP?

Call today to speak with a licensed insurance agent to review and compare Medicare Special Needs Plans that may be available in your area.

An agent can then help you review the details of each plan, including costs, coverage, network providers, terms, conditions and more so that you can make an informed decision about the best plan for your needs.

Find out if you are eligible, and find a plan that may be the right fit for your unique health care needs.

 

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