Special Needs Plans (SNPs) are a type of Medicare Advantage (Part C) plan for people with specific needs relating to a medical condition. Different SNP types can help an individual in different ways.
To be eligible for an SNP, a person may receive both Medicare and Medicaid benefits or live in a specialized facility, such as a nursing home.
These plan types offer services aimed specifically at the populations they will serve.
Through a Medicare Advantage plan, also called Part C, a person may get:
Private insurers administer these bundled plans, rather than the Centers for Medicare & Medicaid Services (CMS).
One type of Medicare Advantage plan is an SNP. These plans are for people with specific health conditions or healthcare needs and who also have Medicaid.
Medicare tailors these plans to a person’s specific needs. Examples of SNP services may include:
- access to in-network healthcare professionals, facilities, and services that treat their condition
- clinical case management programs that help a person manage their condition
- tailor-made prescription drug coverage
- the possibility of additional services, such as additional covered hospital days
Medicare requires that all SNPs include prescription drug coverage.
SNP availability varies by region and insurance provider. For example, even if a person lives in a region where several Medicare Advantage plans are available, an SNP may not be among them.
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If a person needs an SNP, they may be at higher risk of hospitalization. Ideally, these specialized plans can provide the most targeted care for those in need.
There are three different SNP types:
- chronic conditions
- dual eligible
- institutional
Chronic Conditions SNPs (C-SNPs)
C-SNPs help people who are more likely to require specialist care and medication.
Examples of these conditions may include:
- autoimmune disorders
- cancer
- cardiovascular disease
- chronic alcohol or other substance dependence
- chronic and disabling mental health conditions
- chronic heart failure
- chronic lung disorders
- dementia
- diabetes
- HIV
- end stage liver disease
- end stage renal disease (ESRD)
- neurologic disorders
- severe hematologic disorders
- stroke
By creating disease-specific plans, Medicare allows beneficiaries to ideally receive more focused healthcare that directly meets their needs.
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Institutional SNPs (I-SNPs)
I-SNPs are plans for individuals who have had or are expected to need to live in an institution, such as a nursing home, for 90 days or more or who require regular nursing care in their own home.
Dual Eligible SNPs (D-SNPs)
D-SNPs are for people with both Medicare and Medicaid coverage. D-SNPs often offer extra benefits beyond what a person can get from Original Medicare and Medicaid because people who are eligible for them often have the greatest medical needs.
To be eligible for an SNP through Medicare Advantage, people should meet the following criteria:
- They have specific severe or disabling chronic conditions, such as those in the C-SNP section.
- They are eligible for both Medicare and Medicaid.
- They live in certain institutions, such as nursing homes, or require nursing care at home.
In addition to these considerations, an eligible person must have a participating plan in their state or region.
A person can visit Medicare’s online plan finder to learn more about SNPs and Medicare Advantage options.
Different types of Medicare Advantage plans exist. Some popular plans are HMOs and Preferred Provider Organizations (PPOs).
Many SNPs fall into the HMO plan category. Being a part of an HMO means a person has a primary care doctor who acts as a central point of care. The primary care doctor will make a referral to a specialist as necessary.
These plans typically require someone to choose from a list of in-network doctors, healthcare professionals, and facilities that help save money on healthcare costs.
HMOs are often region-specific, and an insurance company must have an agreement with providers that makes them in network. This means that there are pre-agreed costs and rules specific to the HMO plan.
In some states, a person may be eligible for an SNP, but their region does not yet offer them.
Medicare first offered SNPs in 2006, and, as such, they are a relatively new type of Medicare Advantage plan. They aim to provide care for those who often have the most significant medical needs or require the most targeted care.
If a person wants to know whether an SNP is available in their area, they can go to Medicare’s online plan finder tool.
