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.
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:
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:
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:
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:
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:
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:
Beneficiaries that have one or more of the following chronic or disabling conditions qualify for a C-SNP:
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:
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!