February 7th 2024
By Ari Parker
Discover eligibility requirements for Medicare Special Needs Plans, how they work, and how you can start the process of enrolling.
Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage plan for people who have certain chronic diseases, disabilities, or Medicaid. Special Needs Plans provide additional benefits, insurance options, and medication coverage to meet the needs of people with unique healthcare considerations.
There are three types of Special Needs Plans:
Each kind of plan tailors its coverage and benefits to different conditions and situations. We’ll go over the details of each plan type in this post, and how you can sign up if you’re eligible.
Medicare Special Needs Plans are Medicare Advantage insurance policies that cater to people who have chronic conditions, disabilities, or Medicaid. They provide additional coverage to meet unique healthcare needs.
Dual Eligible Special Needs Plans (D-SNPs) are insurance policies for people who qualify for both Medicare and Medicaid. They can provide extra benefits to pay for food, over-the-counter items, and rent assistance.
Chronic Condition Special Needs Plans (C-SNPs) are plans for people with chronic or disabling conditions. They provide additional support for beneficiaries that have diabetes, heart failure, chronic lung disorders, autoimmune diseases, or other disorders.
Institutional Special Needs Plans (I-SNPs) are plans for people who need a level of care provided by skilled nursing or other similar facilities. They provide benefits to help within this type of residence.
Not everyone can enroll in a Medicare Special Needs Plan. These Medicare Advantage plans serve people with chronic or disabling conditions, or people who also have Medicaid.
Medicare SNPs have to cover all services provided by Original Medicare (Part A and B). They can also include additional benefits beyond what Original Medicare provides. Depending on which of the three types of SNPs a beneficiary has, these benefits may include:
Vision care
Dental care
Hearing aids and services
Prescription drug coverage
Healthy food and rent/utility assistance
Extra attention for better care
You’ll have to meet the eligibility criteria for whichever SNP is most applicable to you based on your health condition, residence, or Medicaid status.
There are three types of Medicare Advantage Special Needs Plans that cater to different healthcare needs and living circumstances.
You may hear the term “dual eligibles” when referencing Dual Eligible Special Needs Plans. A person who is dually eligible is someone who has, or can qualify for, both Medicare and Medicaid. In case you’re unfamiliar with Medicaid, the program provides health coverage for people with low incomes and resources.
Medicare Advantage insurance carriers tailor D-SNPs to meet the needs of these dual-eligible beneficiaries by coordinating coverage between the two programs. This provides a more comprehensive healthcare experience. D-SNPs can also include additional benefits beyond Original Medicare such as monthly or quarterly allowances for:
Healthy foods
Over-the-counter items
Rent and utility assistance
Transportation to the doctor or other medical facility
Health and wellness programs
D-SNPs can also provide coverage for dental, hearing, and vision services.
C-SNPs are Medicare Advantage policies for people with specific chronic or disabling conditions, such as diabetes, heart failure, chronic lung disorders, or autoimmune diseases. For a full list of eligible conditions, skip to the section on qualifying for Special Needs Plans. The goal with C-SNPs is to provide specialized coverage for care and services to manage these conditions effectively.
C-SNPs can come with additional benefits such as:
Disease management programs
Care coordination services
Greater access to specialists
Comprehensive prescription drug coverage
Telehealth services
Vision and dental coverage
Health and wellness programs
I-SNPs are tailored to people who live in places like skilled nursing homes or who require nursing care at home. These plans provide healthcare services that meet the unique needs of adults who need this specialized care. This can include people with intellectual disabilities, cognitive impairments, or other limitations. Jump to the qualifications section below for a comprehensive list of eligible facilities.
Benefits of an I-SNP can include:
Skilled nursing care from a dedicated staff
Care coordination
Prescription drug coverage
Physical therapy, occupational therapy, and other rehabilitation services
Dental, vision, and hearing coverage
Telehealth services
The type of Medicare Special Needs Plan that you qualify for depends on your Medicare status, health circumstances, residential status, and location. Before you sign up for an SNP you need to first:
Enroll in Original Medicare (Part A and Part B)
Live in a plan’s service area (some SNPs aren’t available in every state and county)
Once you meet these qualifications, you can check if you’re eligible for one of the three types of SNPs. We break down the eligibility requirements for each type of plan in detail below.
To qualify for a D-SNP, you have to be eligible for both Medicare and Medicaid. You’re eligible if you get help from:
Medicare Extra Help (also called Low-Income Subsidy, or LIS)
Beneficiaries that have one or more of the following chronic or disabling conditions qualify for a C-SNP:
Chronic alcohol and other dependence
Certain autoimmune disorders
Cancer (excluding pre-cancer conditions)
Certain cardiovascular disorders
Chronic heart failure
Dementia
Diabetes mellitus
End-stage liver disease
End-Stage Renal Disease (ESRD) requiring dialysis (any mode of dialysis)
Certain severe hematologic disorders
HIV/AIDS
Certain chronic lung disorders
Certain chronic and disabling mental health conditions
Certain neurologic disorders
Stroke
Beneficiaries who need the intensive care of a facility or live or expect to live in one of the following residences for 90 days straight are able to enroll in an I-SNP:
Nursing home
Intermediate care facility
Skilled nursing facility
Rehabilitation hospital
Long-term care hospital
Swing-bed hospital
Psychiatric hospital
Other similar facility
If you meet any of the above requirements, already have Medicare, and live in an area that has the right type of Special Needs plan, you are able to enroll.
Requirements and the application process for Special Needs Plans are confusing. If you think you may qualify or need a Medicare plan that better fits your health and financial needs, we’re here to help!
Find the right Medicare plan for you by speaking with a caring, unbiased Chapter Advisor at 855-900-2427 or scheduling a time to talk.
