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Your Guide to Medicare Advantage Special Needs Plans (SNPs)

In this article:  

What is a Special Needs Plan? Jump to
What are the Benefits of a Special Needs Plan?Jump to
What is a Chronic Condition SNP (C-SNP)? Jump to
What is an Institutional SNP (I-SNP)? Jump to
What is a Dual-Eligible SNP (D-SNP) Jump to

What are Special Needs Plans?

There are different types of Medicare Advantage Plans designed to help different types of people get the plan that best matches their lifestyle. Some plans have fewer in-network providers, others allow greater flexibility to get some coverage for out-of-network doctors, and some are meant for people meeting special circumstances. That’s where Special Needs Plans (or SNPs – often times pronounced as “snips”) come in.

Special Needs Plans limit membership to people meeting specific characteristics or diseases, such as cardiovascular disorders and diabetes mellitus, because these plans tailor their benefits, drug formularies and providers to best help those using the plans.

What are the Benefits of a Special Needs Plan?

SNPs usually come with benefits that you don’t typically find in a standard Medicare Advantage Plan or Original Medicare. In addition to tailored benefits focused on your disease or health situation, these plans include care coordinators. These coordinators help you manage your health care by scheduling appointments and navigating the plan’s benefits to maximize care.

Also, all SNPs must have prescription drug coverage (Medicare Part D).

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What is a Chronic Condition Special Needs Plan (C-SNP)?

Chronic Condition Special Needs Plans (C-SNPs) are meant for people who suffer from severe or disabling chronic conditions. These conditions often lead to frequent hospitalization or adverse health outcomes, thus requiring specialized treatment plans that differ from a typical Medicare Advantage Plan.

There are 15 Special Needs Plan-specific chronic conditions:

  • Chronic alcohol and other drug dependence
  • Autoimmune disorders* like rheumatoid arthritis
  • Cancer, excluding pre-cancer conditions or in-situ status
  • Cardiovascular disorders* like some heart diseases
  • Chronic heart failure
  • Dementia
  • Diabetes mellitus
  • End-stage liver disease
  • End-stage renal disease (ESRD) requiring dialysis
  • Severe hematologic disorders*
  • Chronic lung disorders* like COPD
  • Chronic and disabling mental health conditions* like anxiety and depression
  • Neurologic disorders
  • Stroke

*Not all conditions within this disorder qualify and are limited to specific diseases or illnesses.

What is an Institutional Special Needs Plan (I-SNP)?

An Institutional Special Needs Plan (I-SNP) is a Medicare Advantage Plan designed for people who live in long-term care nursing facilities or require nursing care at home. I-SNPs restrict enrollment for those who are or will be using those facilities for 90 days or longer.

What is a Dual-Eligible Special Needs Plan (D-SNP)?

Dual-Eligible Special Needs Plans (D-SNPs) are Medicare Advantage Plans for enrollees who qualify for Medicare and Medicaid.

These plans help coordinate their care and benefits to help those with the highest need. With a D-SNP, Medicare and Medicaid pay most or all the out-of-pocket costs.

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