What Are Medicare Advantage Special Need Plans (SNPs)?

Medicare Advantage Special Needs Plans (SNPs) are designed to help individuals with specific healthcare needs, such as chronic conditions or chronic illnesses, long-term care requirements, or financial hardships. A Medicare SNP provides all Medicare services under one program.

In 2003, the United States Congress passed the Medicare Modernization Act, establishing Medicare Special Needs Plans (SNPs) for qualifying individuals with unique healthcare needs. Today, more than 5.7 million Medicare beneficiaries are enrolled in these programs, doubling since 2018 and making up 19% of all Medicare beneficiaries in 2023.

What are the 3 types of SNPs?

SNP Medicare programs are divided into three categories and offer a variety of care options and unique benefits.

• Chronic Condition Special Needs Plans (C-SNPs)
  
• Institutional Special Needs Plans (I-SNPs)
  
• Dual Special Needs Plans (D-SNPs)

Chronic Condition Special Needs Plans (C-SNPs)

C-SNPs are for individuals with chronic severe or disabling conditions, such as:

Institutional Special Needs Plans (I-SNPs)

I-SNPs are designed for those who require a stay in a long-term care facility, intermediate care center for individuals with intellectual disabilities, skilled nursing centers, and resident psychiatric facilities for at least 90 days. I-SNPs may also provide coverage for those who live at home but need extensive care at their residence.

In addition to providing coverage for long-term care, I-SNPs often provide a nurse practitioner to coordinate care between a primary care physician (PCP) and the facility’s care team. The nurse practitioner will also visit their Medicare patients in the long-term facility or home to monitor their care. I-SNPs are the least common type of Medicare special needs plan, accounting for only 2% of all SNP enrollees, but their popularity is growing, nearly doubling between 2018 and 2023.

Dual Special Needs Plans (D-SNPs)

D-SNPs provide additional coverage for those who qualify for both Medicare and Medicaid coverage. These individuals have unique healthcare needs based on their mental or physical health and financial needs.

D-SNPs are the most common type of special needs plans, making up 89% of all SNPs. Not only do dual special needs plans provide for healthcare needs, they sometimes help pay for extra medical-related expenses. These plans may cover:

• Flex cards to help pay for groceries, over-the-counter medications, transportation, and other approved goods and services
• Medicaid coverage to pay Part B medical services, such as doctor's visits and other healthcare providers
• Copayments for medications

D-SNPs also provide care coordinators who can help disseminate information on local community resources and navigate through Medicare and Medicaid benefits.

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What are SNP advantages and disadvantages?

SNPs are developed for specific needs, offering qualifying individuals several advantages. Depending on the plan, these may include:

• Care coordination to ensure that all healthcare providers work together and all necessary treatments are provided
• Additional benefits, such as prepaid flex cards for groceries, transportation, and other approved expenses
• Tailored benefits that may include specialists and special drug benefits
• Extra coverages such as vision, dental, hearing, and fitness services
• Prescription drug coverage
• Affordability

Some of the disadvantages include:

• Preapproval for care may be required depending on the insurance provider
  
• Limited choice of healthcare providers
• Lack of availability in certain areas
• Referrals required for specialists
  

How much do Medicare SNPs cost?

Plan costs vary. Some SNPs require payments in addition to your Medicare Part B premiums, and they may have different copays and deductibles. If you are already enrolled in a Medicare Advantage plan, the cost should be similar to what you already pay. However, for those who qualify for Medicare and Medicaid (D-SNP), most costs are covered, plus you may qualify for additional flex cards to help with groceries, transportation, and other covered expenses.

Who qualifies for Medicare Special Needs Plans?

To qualify for a Medicare SNP, you must already be enrolled in Medicare Parts A and B, or Medicare Advantage (which is the same as Part C), and live in an area where SNPs are offered. Because private insurance companies offer Medicare Advantage programs, providers can determine where they choose to do business. For that reason, Medicare SNPs are not available in some areas.

Each type of Medicare SNP has different requirements:

• C-SNPs require a doctor’s note stating that you have a qualifying health condition.
• I-SNPs must show that you are living in an approved long-term care facility for at least 90 days or meet your state’s requirements necessitating extensive home care services.
• D-SNPs require proof of Medicaid coverage.

You will not automatically be enrolled in a Medicare Special Needs Plan. Generally, you would join during determined Medicare Advantage open enrollment periods. However, you may also be able to register during special enrollment periods if you meet the necessary criteria. You also qualify for special enrollment if you are already enrolled in both Medicare and Medicaid.

You can learn more about the Medicare SNP programs offered in your area, how much they cost, and whether you qualify by visiting the Medicare Plan Finder.