Special Needs Plans (SNPs) are a type of Medicare Advantage plan offered to those who have specific needs related to a medical condition.

To be eligible for a Special Needs Plan, a person may receive both Medicare and Medicaid benefits, or live in an institution, such as a nursing home. These plan types offer services aimed specifically at the populations they will serve.

This article will detail more about SNPs and the condition types that can qualify for coverage.

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A person with an autoimmune disorder may be eligible for a Medicare Special Needs Plan.

Through a Medicare Advantage plan, a person gets their Part A (hospital benefits), Part B (medical benefits), and in many instances, Part D (prescription drug benefits). Private insurers rather than the Centers for Medicare and Medicaid services administer these bundled plans.

Medicare Advantage programs offer SNPs to individuals who have a chronic condition. Medicare tailors these plans toward those with certain types of medical conditions and their specific needs. Examples include:

  • access to in-network providers that treat their condition
  • clinical case management programs that help a person manage their condition
  • prescription drug coverage that would take into consideration the typical medications a person with a specific medical condition may need
  • the possibility of additional services, such as providing for more covered days in the hospital than would usually be expected

Medicare requires that all SNPs offer prescription drug coverage.

The availability of SNPs varies by region and insurance provider. Even if a person lives in a region where there are several Medicare Advantage plans, an SNP may not be available.

The medical community usually consider beneficiaries of SNPs to be at higher risk for hospitalizations. Ideally, offering 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

Chronic condition SNPs (C-SNPs) help people who are more likely to require specialist care and medication.

Examples of these conditions may include:

By creating disease-specific plans, Medicare beneficiaries can ideally receive more focused healthcare that directly meets their needs.

A study about people with diabetes and SNPs found those who participated in SNPs had lower rates of hospitalization. They were also less likely to be readmitted to the hospital compared to those who participated in fee-for-service Medicare plans.

Institutional SNPs

Institutional SNPs (I-SNPs) are plans for those who live in an institution, such as a nursing home, or who require regular nursing care at their own home.

Dual Eligible SNPs

Enrollees to a Dual Eligible SNP (D-SNP) are intended for those who have both Medicare and Medicaid coverage. According to the Integrated Care Resource Center, this group represents people with the highest medical costs as they often have complex medical needs.

To be eligible for an SNP through Medicare Advantage, a person must first have both Medicare Part A and Part B. An individual would usually qualify for these through being 65 years of age or having a disability.

It may be possible for a person to become eligible at an earlier age if they have end-stage renal disease or amyotrophic lateral sclerosis. A person must also have the medical condition or meet the requirements for the SNP they are attempting to join.

In addition to these considerations, an eligible person must have a participating plan in their state or region.

Different types of Medicare Advantage plans exist. Some popular ones are Health Maintenance Organizations (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 that acts as a central point of care. The primary care doctor will make a referral to a specialist as needed.

These plans typically require a person to choose from a list of in-network providers that help to 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.

There are some states where 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 or most targeted medical needs.

If a person wants to know if an SNP is available in their area, they should go to Medicare’s online Plan Finder.

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