Special Needs Plans (SNPs) are a type of Medicare Advantage plan for those with specific needs relating to a medical condition.
To be eligible for an SNP, 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.
Through a Medicare Advantage plan, a person gets:
Private insurers administer these bundled plans, rather than the Centers for Medicare & Medicaid Services.
Medicare Advantage programs offer SNPs to individuals with certain conditions or specific healthcare needs or who also have Medicaid. Medicare tailors these plans to each person’s specific needs. Examples of SNP services may 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 someone 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 be unavailable.
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The medical community usually considers 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 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
- neurologic disorders
- severe hematologic disorders
- stroke
By creating disease-specific plans, Medicare beneficiaries can ideally receive more focused healthcare that directly meets their needs.
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Institutional SNPs (I-SNPs)
I-SNPs are plans for those 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 those who have 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 D-SNPs often have the greatest 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 usually qualifies for these by being 65 years of age or having a disability.
People who meet the following criteria should be eligible for SNPs:
- individuals who have specific severe or disabling chronic conditions, such as those in the C-SNP section
- individuals eligible for both Medicare and Medicaid
- individuals who live in certain institutions, such as nursing homes, or who require nursing care at home
In addition to these considerations, an eligible person must have a participating plan in their state or region.
People can find out more about SNPs and Medicare Advantage options in their area by visiting Medicare’s online Plan Finder.
There are different types of Medicare Advantage plans. 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 providers 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.
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 can go to Medicare’s online Plan Finder.