How to Enroll in a Special Needs Plan (SNP)
In this article:
|What is a SNP?||Jump to|
|Can I Join a SNP?||Jump to|
|When Can I Enroll in a SNP?||Jump to|
|When Can I Enroll in a C-SNP?||Jump to|
|When Can I Enroll in a D-SNP?||Jump to|
|When Can I Enroll in an I-SNP?||Jump to|
|Can I Lose My SNP Coverage?||Jump to|
What is a SNP?
Special Needs Plans (SNPs) are Medicare Advantage Plans tailored for people with specific diseases, health care needs or limited incomes. SNPs shape their benefits, providers and drug formularies to best help give the proper care to those who need them.
There are three types of SNPs:
- Chronic Condition Special Needs Plans (C-SNPs) – for people with debilitating or chronic health issues
- Dual-Eligible Special Needs Plans (D-SNP) – for people who are eligible for both Medicare and Medicaid
- Institutional Special Needs Plans (I-SNP) – for people who live in a long-term care facility or need nursing services at home
Each SNP limits their enrollment to those who meet the plan’s eligibility requirements.
Can I Join a SNP?
You can join a Special Needs Plan if you:1
- Have Medicare Part A (hospital insurance)
- Have Medicare Part B (medical insurance)
- Live in the plan’s service area
- Meet the plan’s specific eligibility requirements
Each SNP has its own set of plan-specific requirements, which you’ll find below.
To enroll in a C-SNP, you must have one or more of the following chronic or disabling conditions:2
- Chronic alcohol and other drug dependencies
- Autoimmune disorders*
- Cancer, excluding pre-cancer conditions or in-situ status
- Cardiovascular disorders*
- Chronic heart failure
- Diabetes mellitus
- End-stage liver disease
- End-stage renal disease (ESRD) requiring dialysis
- Severe hematologic disorder limited to:
- Chronic lung disorders*
- Chronic and disabling mental health conditions*
- Neurologic disorders*
*A C-SNP does not cover all conditions within these broader illness classifications. Click here to see the complete list of illnesses.
To enroll in a D-SNP, you must be eligible for both Medicare and Medicaid.
To enroll in an I-SNP, you must require services provided by one of the following facilities for at least 90 days:
- Long-term care (LTC) skilled nursing facility
- LTC nursing facility
- Intermediate care facility for individuals with intellectual disabilities
- Inpatient psychiatric facility
When Can I Enroll in a SNP?
There are a limited number of ways to join, switch or drop a Medicare Advantage Special Needs Plan. The most common way to do this is through an enrollment period. Some Medicare enrollment periods happen annually, while life events trigger others. Below we break down these periods.
Initial Enrollment Period
You can join a SNP during your Initial Enrollment Period. This is when you’re first eligible to enroll in the Medicare program. This is a seven-month period that begins three months before the month of your 65th birthday and ends three months after the month you turn 65.
Medicare Annual Enrollment Period
Each year between October 15 – December 7, anyone with Medicare can make changes to their health care plan. This time window is called the Medicare Annual Enrollment Period (AEP). You can add, drop or switch your Medicare Advantage Plan during this time. You can also enroll or change your SNP during this time if you still meet the plan’s enrollment requirements. Click here to learn more about this Medicare open enrollment period.
Medicare Advantage Open Enrollment Period
The Medicare Advantage Open Enrollment Period happens annually between January 1 – March 31. During this time, people enrolled in a Medicare Advantage Plan can make one change to their plan. Some examples of the changes you can make include switching from one MA plan to another MA plan or dropping your Medicare Advantage Plan and reverting to Original Medicare. Click here to learn more about the Medicare Advantage Open Enrollment Period.
Special Enrollment Periods
There are ways to change your Medicare Advantage Plan outside of the annual enrollment periods. These changes are called Special Enrollment Periods (SEPs). These SEPs are activated by specific life events, such as moving to a new address that’s not in your plan’s service area, moving to a new address with new plan options, your Medicare provider no longer offers your health plan or other special situations.
C-SNPs, D-SNPs and I-SNPs have their own qualifying events which trigger plan-specific SNPs.
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When Can I Enroll in a C-SNP?
You can enroll in a C-SNP at any time if you meet the eligibility criteria. If you are diagnosed with a qualifying chronic or disabling condition, you don’t have to wait for an annual enrollment period.3
When Can I Enroll in a D-SNP?
If you have both Medicare and Medicaid coverage, then you can join, switch or drop your Medicare Prescription Drug Plan (Medicare Part D), Medicare Advantage Plan or D-SNP once during the following periods:
- January – March
- April – June
- July – September
If you make a change to your plan during these periods, it will take effect on the first day of the following month. You can’t use a Special Enrollment Period between October – December to avoid conflict with the Medicare AEP between October 15 and December 7. If you make a change during AEP, your new plan will go into effect on January 1.
When Can I Enroll in an I-SNP?
You can enroll in an I-SNP when you move into a long-term care or skilled nursing facility or require nursing care at home for at least 90 days. You can enroll before reaching your 90th day of care if you verify that your condition will need at least 90 days of care.
Can I Lose My SNP Coverage?
You can stay enrolled in your C-SNP, D-SNP or I-SNP for as long as you continue meeting the plan’s requirements. If you were to no longer meet your plan’s requirements, such as an I-SNP enrollee no longer needing the services at a long-term-care facility, then you can use a Special Enrollment Period to find a new Medicare plan.1
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1 “How Medicare Special Needs Plans (SNPs) Work,” Medicare.gov, Accessed: Feb. 17, 2022.
2 “Chronic Condition Special Needs Plans (C-SNPs),” CMS.gov, Accessed: Feb. 17, 2022.
3 “Your Guide to Medicare Special Needs Plans (SNPs),” Page 15, Centers for Medicare and Medicaid Services, Accessed: Feb. 17, 2022.
Denise Austin, 65, Ensurem Ambassador
Best-Selling Author, Creator of Fit Over 50 Magazine
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