Are you enrolled in Medicare Advantage—or thinking about signing up for it? Then you should know about Medicare Advantage Special Needs Plans (SNPs).

Why? Because sometimes, life changes—and your health coverage needs to change with it. Medicare Advantage SNPs can help protect your access to benefits and care at a vulnerable time.

What are Medicare Advantage Special Needs Plans (SNPs)?

SNPs are a type of Medicare Advantage plan designed for people with specific health or financial needs. These plans are offered and administered by private health insurance companies. They’re either HMOs (plans that provide coverage and benefits within a defined network) or PPOs (plans that offer a broader selection of in- and out-of-network providers). 

Like all Medicare Advantage plans, SNPs must provide the same Part A and Part B benefits that original Medicare does. They also must include Part D prescription drug coverage.

Medicare Advantage SNPs fall into one of three categories. These categories are designed around the needs of specific groups of beneficiaries. Learn who they’re for, what they cover, and how to enroll below.

Who qualifies for Medicare Advantage Special Needs Plans (SNPs)?

Before you can enroll in a Medicare Advantage SNP, there are special eligibility requirements you must meet. Generally speaking, you may qualify if you have at least one of the following:

• A low income – at or below 138% of the federal poverty level (though rules vary by state)
• Certain medical conditions – including but not limited to cancer, dementia, diabetes, and kidney disease
• Special health care requirements – you need skilled physical or psychiatric care only available on an inpatient basis

You also must live in the SNP’s “defined coverage area.” Because SNPs are private health insurance plans, the companies who administer them get to decide where and when to offer them. You can check with your State Health Insurance Assistance Program (SHIP) to see what SNPs may be available to you. SHIP counselors provide personalized, qualified, and unbiased guidance at no cost to you.

What are the three types of Medicare Advantage Special Needs Plans?

Each Medicare Advantage SNP focuses on meeting specific needs and provides care coordination, tailored benefits, and relevant formularies (list of covered prescription drugs). They are:

• Chronic Condition SNP (C-SNP): These plans cover people with one or more specific complex or disabling health conditions ranging from alcohol dependence to stroke. If you enroll in a C-SNP, you will get your care within a network of providers who specialize in treating your condition(s).
• Dual Eligible SNP (D-SNP): These plans cover people with low incomes who qualify for both Medicare and Medicaid. If you enroll in a D-SNP, you will have access to trained professionals who will help you understand, navigate, and use your benefits. You also may get additional benefits and services that support your health and wellness.
• Institutional SNP (I-SNP): These plans cover people who already live in a skilled nursing facility (nursing home) or who need the type of high-level care only provided in a skilled facility. In order to enroll in an I-SNP, you generally will need to have skilled nursing care for at least 90 days in a row.  

What are the benefits of a Medicare Advantage Special Needs Plan?

SNPs must offer the same benefits that are available under other Medicare Advantage (MA) plans. People choose to enroll in SNPs because they typically offer more and additional services targeted to the populations they serve.

“For people managing chronic conditions or multiple coverage programs like Medicare and Medicaid, SNPs can really help simplify care and improve outcomes,” said Ryan Ramsey, NCOA Associate Director of Health Coverage and Benefits. 

How do I enroll in a Medicare Advantage Special Needs Plan?

Learn more about SNP coverage and eligibility by visiting Medicare’s resource page.  And remember, your local SHIP office is available to help.

Source

1. Medicare.gov. Special Needs Plans (SNP). Found on the internet at https://www.medicare.gov/health-drug-plans/health-plans/your-coverage-options/SNP