Medicare Special
Needs Plans (SNP)
What are Medicare Special Needs Plans?
Special Needs Plans (SNPs) are a type of Medicare Advantage Plan. They’re offered by private insurance companies that have contracted with the Centers for Medicare and Medicaid Services (CMS) to offer Medicare plans. Special Needs Plans are unique plans that are designed specifically for a limited group of people, offering certain benefits and coverage that is extra helpful to the eligible group.
There are three categories of SNPs.
Dual Special Needs Plan (D-SNP)
Who’s eligible?
Individuals who have both Medicare and Medicaid.
What’s covered?
Dual Special Needs Plans (D-SNPs) have a focus on bundling your coverage from multiple sources into one plan, reducing your need to coordinate with Medicare, Medicaid, a prescription drug plan, and more.
Common benefits in Dual plans include:
- Prescription drug coverage
- Care coordinator
- Vision
- Dental
- Hearing
- Fitness benefits
- Transportation
- Over-the-counter benefits
- Telehealth
- And maybe more!
Chronic Condition Special Needs Plan (C-SNP)
Who’s eligible?
Medicare beneficiaries with one or more of the following conditions:
- Chronic alcohol and other dependence
- Autoimmune disorders
- Cancer (excluding pre-cancer conditions)
- Cardiovascular disorders
- Chronic heart failure
- Dementia
- Diabetes mellitus
- End-Stage Renal Disease (ESRD) requiring dialysis (any mode of dialysis)
- Severe hematologic disorders
- HIV/AIDS
- Chronic lung disorders
- Chronic and disabling mental health conditions
- Neurologic disorders
- Stroke
Not all C-SNPs cover all conditions. For example, one Chronic Condition Special Needs Plan may only cover individuals with cancer. That plan might have a network including oncologists, a prescription formulary with cancer treatments included, additional at-home or palliative care benefits, etc.
What’s covered?
Because each condition requires a unique benefit set, Chronic Condition Special Needs Plans may look very different. In general, you can expect them to have a network including relevant specialists, prescription drug coverage, and additional support beyond what you may have found in other health insurance. Many C-SNPs will also have care coordinators who work to ensure your providers are all on the same page.
Institutional Special Needs Plan (I-SNP)
Who’s eligible?
Medicare beneficiaries who live in an institution – a long-term care facility, psychiatric care facility, etc. – or require nursing care at home. The threshold for eligibility is 90 days or longer.
What’s covered?
Institutional Special Needs Plans (I-SNPs) typically have a focus on preventative care and in-place treatment to avoid repeated hospital visits. That usually means that services will be brought to you, rather than you having to visit a doctor’s office. Your institution will also have to provide CMS with a clear plan for your care, to ensure that you’re receiving the services and care necessary.
Enrollment Eligibility
Annual Enrollment Period (AEP)
Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?
Initial Enrollment Period (IEP)
Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.
Special Enrollment Period (SEP)
You may be eligible if you experience a qualifying life event such as moving to a new zip code, losing employer coverage, or change in Medicaid status.
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Further Reading:
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Last Updated: October 13, 2023 MULTIPLAN_ETQEZMwebsite_2024_M