Managing your healthcare can be complicated, especially when you have a severe chronic condition or need special care. If you have Original Medicare and live in the correct service area, Medicare Advantage Special Needs Plans (SNPs) might cover extra services that you need.
Like other Medicare Advantage plans, SNPs combine the hospital and medical coverage provided by Medicare Part A and Part B in one private health plan. Every SNP also includes Part D coverage to help pay for prescription medications.
What makes these plans different is how they tailor their benefits, provider networks, and covered medications to the people they serve. They also include care coordination to help members manage their healthcare. However, you must meet a plan’s eligibility rules and live in its service area to qualify.
In this guide, we’ll explore the three types of SNPs, what they cost, and key points to compare before choosing a plan.
And if it still feels like too much to sort through on your own, Chapter’s Medicare Advisors can help you review your options across Original Medicare, Medicare Advantage, and Medigap.
Key takeaways:
SNPs are types of Medicare Advantage plans for people who suffer from certain chronic health conditions, have both Medicare and Medicaid, or need an institutional level of care.
Every SNP includes Part D coverage and care coordination. However, costs, provider networks, covered prescriptions, and extra benefits vary by plan.
A plan that works well for one person may not be a good fit for someone else. Compare your doctors, prescriptions, budget, and local plan options before enrolling.
What is a Medicare Advantage Special Needs Plan?
A Medicare Advantage Special Needs Plan (SNP) is a Medicare Advantage (Part C) plan that limits enrollment to people with some sort of special need: either a health condition, specialty care need, or limited financial resources.
Like other Medicare Advantage plans, SNPs are an alternative to Original Medicare offered by private insurers. These plans bundle coverage for Medicare Part A (hospital insurance) and Part B (medical insurance). All SNPs also include Part D prescription drug coverage, care coordination services, and special benefits. For example, someone with diabetes mellitus would get access to providers, drugs, and other benefits that best help them manage their condition. SNP care coordinators help members access appropriate medical care and resources. They might help you schedule appointments, understand your prescriptions, and even communicate with your healthcare providers. Specific support services vary by plan.
Anyone who has Part A and Part B can join a standard Medicare Advantage plan during an appropriate enrollment period if they live in that plan’s service area. SNPs are only available to people who meet the standard Medicare Advantage requirements and specific eligibility requirements for the SNP.
Who qualifies for Medicare Advantage Special Needs Plans?
SNPs aren’t one-size-fits-all. Each of the three types serves people with a different health, financial, or care situation:
Dual-Eligible Special Needs Plan (D-SNP): For people who have both Medicare and Medicaid
Chronic Condition Special Needs Plan (C-SNP): For people with one or more qualifying severe or disabling chronic conditions
Institutional Special Needs Plan (I-SNP): For those who need an institutional level of care or live in a specialty care facility for at least 90 consecutive days
Dual-Eligible SNP (D-SNP)
If you have both Medicare and Medicaid, coordinating care can be difficult. Each program has different regulations and administrative burdens. D-SNPs are designed to make coordinating care between both programs easier.
Medicare is a federal health insurance program for Americans aged 65 or older (though some people with certain disabilities can join the program early). Medicaid is a joint federal and state program for eligible low-income individuals and their families, pregnant people, and people with disabilities.
If you qualify for both programs, a D-SNP helps coordinate your benefits. However, the level of coordination varies across plans. For example, some D-SNPs accept people who receive partial Medicaid benefits, while others require full Medicaid benefits. Some plans, called integrated D-SNPs, combine your Medicare benefits with most or all of your Medicaid benefits through a single plan.
Plan availability also varies by location. New Hampshire, Vermont, and Alaska don’t have D-SNPs available. Other states, like Wyoming, only have D-SNPs available in certain counties. Although the number of insurers offering D-SNPs has increased, it’s possible for a certain plan to be available one year but not the next.
Chronic Condition SNP (C-SNP)
Managing a serious or long-term condition often means juggling appointments, medications, specialists, and other healthcare needs. A C-SNP brings these parts of your care together in a plan designed around your condition.
To enroll, a medical provider must confirm that you have a qualifying severe or disabling chronic condition covered by the plan. Once your condition’s confirmed, you can use a Special Enrollment Period to join an eligible C-SNP.
Qualifying conditions can include:
Alcohol and substance use disorders
Autoimmune disorders (limited)
Cancer
Cardiovascular disorders (limited)
Chronic GI diseases (limited)
Chronic and debilitating mental health conditions (limited)
Chronic heart failure
Chronic kidney disease and End-Stage Renal Disease
Chronic lung disorders (limited)
Dementia
Diabetes mellitus
HIV/AIDS
Neurological disorders (limited)
Severe hematological disorders (limited)
Stroke
Institutional SNP (I-SNP)
People who need ongoing, intensive care often have complex healthcare needs. I-SNPs are designed to coordinate care for people who need or expect to need an institutional level of care at home or live in a qualifying facility for at least 90 days.
Examples include but aren’t limited to:
Intermediate care facility
Long-term care hospital
Psychiatric hospital
Rehabilitation hospital
Skilled nursing facility
Swing bed hospital
Some plans may cover similar facilities that offer long-term or specialized health care needs. But remember that plans vary by location.
What are the benefits of a Medicare Advantage Special Needs Plan?
For the right person, a SNP can make a complicated healthcare situation easier to manage.
Some of the main benefits of a Medicare Advantage SNP can include:
Care coordination: SNPs help organize care among doctors, specialists, pharmacies, and other providers.
Benefits beyond Original Medicare: Many plans include coverage for dental, vision, hearing, transportation, or other services.
Built-in Part D coverage: Every SNP covers prescription drugs.
Lower costs: Many people with Medicare and Medicaid get help with Medicare premiums and cost-sharing.
Still, an SNP isn’t automatically the best choice just because you qualify. Consider these potential drawbacks before enrolling:
Network restrictions: You may need to use the plan’s doctors, specialists, pharmacies, or facilities instead of your preferred ones to receive coverage or pay lower prices.
Limited availability: The type of SNP that fits you best may not be available in your area.
Yearly plan changes: Premiums, provider networks, drug coverage, extra benefits and other plan details can change each year.
Ongoing eligibility: You need to continue meeting the plan’s eligibility requirements to stay enrolled.
Ultimately, whether a SNP is right for you depends on your health conditions, doctors, prescriptions, budget, and plan availability. One of our Medicare Advisors can help you review plan documents so you understand exactly what’s covered.
How much do Special Needs Plans cost?
The cost of a SNP is different for everyone. It depends on:
The plan
Where you live
The special needs category you qualify for
To understand a plan’s full cost, it’s important to consider these factors:
Part B premium: Most members keep paying their monthly Medicare Part B premium.
Plan premium: Some SNPs come with an additional monthly premium.
Deductibles and cost-sharing: You may owe a deductible, copay, or coinsurance charge when getting care.
Prescription drug costs: All plans must provide Medicare drug coverage, but costs, coverage, and pharmacy availability varies.
Remember that even zero-premium plans can have other out-of-pocket costs. And the price of plans varies. For example, some D-SNPs cover all out-of-pocket costs while others still require small copays.
Get help choosing the right Special Needs Plan
Once you determine your eligibility for a Medicare Advantage SNP you need to figure out which plan is best for you. You’ll need to make sure your prescriptions are covered, your doctors and pharmacies are in network, and your desired benefits are included.
This can feel overwhelming to sort through on your own, especially when plans and networks can undergo changes each year. But you don’t have to do it alone.
Chapter offers free Medicare advice from licensed, independent Medicare Advisors. We can help figure out whether you qualify for a SNP and compare plans across carriers based on your healthcare needs.
Chat with us today at 855-900-2427, or book an appointment with an Advisor to discuss your unique situation, and get the care you need.
Sources
Centers for Medicare & Medicaid Services. (2024) Chronic Condition Special Needs Plans (C-SNPs).
https://www.cms.gov/medicare/enrollment-renewal/special-needs-plans/chronic-conditions
Centers for Medicare & Medicaid Services. (2024) Dual Eligible Special Needs Plans (D-SNPs).
https://www.cms.gov/medicare/enrollment-renewal/special-needs-plans/dual-eligible
Centers for Medicare & Medicaid Services. (2024) Institutional Special Needs Plans (I-SNPs).
https://www.cms.gov/medicare/enrollment-renewal/special-needs-plans/institutional
KFF. 10 Things to Know About Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs). (2024). https://www.kff.org/medicare/10-things-to-know-about-medicare-advantage-dual-eligible-special-needs-plans-d-snps/
Medicare.gov (n.d.). Special Enrollment Periods.
Medicare.gov. (n.d.). Special Needs Plans (SNP).
https://www.medicare.gov/health-drug-plans/health-plans/your-health-plan-options/SNP
