Medicare Special Needs Plans (SNP’s) are Medicare Advantage plans designed to meet the unique needs of individuals who fall into three categories: those who have chronic health conditions, those who qualify for Medicare and Medicaid, and those who require institutionalized care. In 2024 more than 6.6 million Americans were enrolled in a SNP. Here’s what you need to know about SNP’s to help you determine if you qualify.
- SNP’s are offered by private insurers, and not all types of SNP’s are available in all areas.
- They are designed to lower out of pocket costs and offer additional features tailored to the needs of enrollees.
- To be eligible for a SNP you must already be enrolled in Medicare Parts A and B.
- Because these are Medicare Advantage plans, you must use medical providers within the insurance carrier’s network. Some insurer’s offer PPO plan types that allow you to go out of network at an increased cost.
- All SNP’s include prescription drug coverage so you will need to check the insurer’s drug formulary to know how your prescription medications are covered.
There are three types of SNP’s each of which has it’s own eligibility requirements:
Chronic Conditions (C-SNP)
These plans are designed for Medicare beneficiaries with one or more disabling chronic conditions. Medicare has identified 15 different chronic conditions that would qualify you for a C-SNP but you may not find all the plans available in your zip code. The most commonly available C-SNP’s are for beneficiaries with diabetes and cardiovascular disorders.
C-SNP’s offer lower out of pocket costs for medications and specialists that treat your qualifying chronic condition. They may cover extra days for a hospital stay as well as a care coordinator to help organize the many aspects of your care including doctors appointments and medications. Plans may also offer supplemental benefits that support your overall well-being including transportation to medical appointments and an allowance for food and utilities.
When you enroll in a C-SNP your doctor must provide verification of the qualifying chronic condition within the first month of your enrollment. You will be asked to reconfirm your eligibility every year.
Dual Eligible (D-SNP)
These plans are designed for individuals who qualify for both Medicare and Medicaid, known as “dual eligibles.” Because Medicaid programs are administered at the state level eligibility requirements will vary by state, as do the type of D-SNP plans offered and when you can enroll in them. In the state of Texas, Medicaid is administered by Texas Health and Human Services, To find out if you are eligible you can apply online at Your Texas Benefits, call 2-1-1 (TTY 711) toll-free Monday through Friday from 8 a.m. to 6 p.m. Central time or visit a Texas Health and Human Services office near you.
Most people have little to no out of pocket costs under a D-SNP. Your Medicare insurer pay its portion first, and Medicaid takes care of the remaining costs. Since it can be difficult to coordinate benefits and access to care between the two programs, the Centers for Medicare and Medicaid (CMS) want D-SNP eligible individuals to receive their Medicaid and Medicare benefits from the same insurer, known as integrated D-SNP’s. Over the next few years CMS will require insurers to transition their D-SNP enrollees to integrated plans making it easier for them to understand their benefits and navigate their healthcare needs.
Institutionalized (I-SNP)
These plans are designed for Medicare beneficiaries who require care in an institutionalized setting such as a skilled nursing facility, psychiatric hospital, or rehab hospital for at least 90 days. I-SNP’s provide comprehensive care in one setting. This eliminates the need to leave the facility for preventive care such as vaccines and reduces the frequency of emergency room visits and hospital stays. Benefits include a care coordination team who work closely with facility staff to create a personalized care plan for each beneficiary. I-SNP’s may include additional benefits such as hearing, dental and vision care.
Special Enrollment Periods
If you are eligible for a Special Needs Plan you will qualify for a Medicare Special Enrollment Period (SEP) that allows you to change plans outside of Medicare’s usual enrollment timelines. There is an SEP specific to each type of SNP that outlines what coverage changes you can make as well as the timeline for making those changes.
In the event you are enrolled in a SNP, and you no longer qualify due to changes in your circumstances or health, you will be granted an SEP to find new coverage.
How Healthcare Educators Can Help
The knowledgeable team of licensed Medicare agents at Healthcare Educators can help you determine if you qualify for a Special Needs Plan. They can advise you on what type of plans are available in your area. They will do a thorough review of your healthcare needs, including your doctors and medications to help you find the plan that is right for you. Contact us today.