What Is a Medicare Special Needs Plan (SNP)?
- January 12, 2024
- Reviewed by John Krahnert
A Special Needs Plan is a type of Medicare Advantage plan (also called Medicare Part C) designed to provide customized care to people with specific health conditions or for beneficiaries who qualify for Medicare and Medicaid.
The coverage offered by a Medicare SNP is built around providing more focused care that better meets the needs of the patient.
Read below to learn more about Special Needs Plans.
What does a Medicare SNP cover?
A Special Needs Plan can work similarly to other types of Medicare Advantage plans.
Medicare Advantage plans offer an alternative way to receive Original Medicare benefits (Part A and Part B), and many Medicare Advantage plans offer additional benefits that aren't covered by Original Medicare.
Medicare Advantage plans come in a variety of types such as HMOs and PPOs. While Original Medicare can be used all over the country, Medicare Special Needs Plans typically feature a network of participating health care providers, pharmacists and suppliers where the plan may be used.
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Who is covered by a Medicare SNP?
As mentioned above, Medicare Advantage plans offer the same benefits covered by Medicare Part A and Part B combined into one plan sold by a private insurance company.
Medicare Advantage Special Needs Plans (C-SNP) cater more specifically to the needs of people with:
- Dependence issues with alcohol or other substances
- Autoimmune disorders
- Cancer
- Cardiovascular disorders
- Chronic heart failure
- Dementia
- Diabetes mellitus
- End-stage liver disease
- End-Stage Renal Disease (ESRD) that requires dialysis
- Severe hematologic disorders
- HIV/AIDS
- Chronic lung disorders
- Strokes
There are also Special Needs Plans that can be available to people who reside in a long-term care facility such as a skilled nursing home.
Some Medicare SNPs are designed for people who are dual-eligible, meaning they are eligible for both Medicare and Medicaid.
What does a Medicare SNP cover?
Each Medicare SNP is designed to offer some unique benefits designed to serve the population for whom that plan is designed.
In addition to the benefits, Special Needs Plans provide all the same basic coverage as Original Medicare. Medicare Advantage SNPs also offer additional benefits that Original Medicare doesn’t cover.
What are the benefits of a Special Needs Plan?
Special Needs Plans can be particularly beneficial because of their focused coverage benefits.
- Care coordination
Some Special Needs Plans feature care coordination services. These plans may assign a care coordinator to each member who serves as a sort of "quarterback" for your care.
Your care coordinator can help you better understand your condition, monitor your treatment regimen to help you stay on track and consult with specialists within the plan network to steer you toward the care you need.
A care coordinator may also set you up with wellness programs, lifestyle activities or a special diet to help you manage your condition. - Specialized networks and drug formularies
Medicare Advantage plans typically feature a network of participating providers.
SNP network providers are typically specialists who focus their care on the very type of condition, symptoms and treatment associated with your situation. The right type of care can be hard to find, and Special Needs Plans can help you find the specialized providers you need.
Medicare Special Needs Plans also generally feature a list of covered prescription drugs that are commonly used to treat your specific condition. - Coverage for ESRD
Depending on where you live, there may be Special Needs Plans designed specifically for people with End-Stage Renal Disease (ESRD, kidney failure requiring dialysis) that are available in your area.
Am I eligible for a Medicare Special Needs Plan?
To be eligible for a Special Needs Plan, you must first be enrolled in Original Medicare and live in the area served by your desired plan.
The additional requirements for each type of SNP plan may also include:
- Chronic Condition SNPs (C-SNP) – You must have a doctor’s note confirming you have the health condition addressed by the plan.
- Institutional SNPs (I-SNP) – You must reside for at least 90 days in a long-term care facility that is served by the plan, or you must meet your state’s guidelines for needing nursing-level care at home for at least 90 days.
- Dual-Eligible SNPs (D-SNP) – You must provide your Medicare and Medicaid enrollment verification.
When can I enroll in a Medicare SNP?
You may enroll in a Medicare SNP during the annual Medicare Advantage and Prescription Drug Plan fall Open Enrollment Period that runs from October 15 to December 7 every year.
You may also enroll in a Medicare SNP if you are granted a Special Election Period. You may be given a Special Election Period if:
- You already have Medicare and then develop a chronic health condition
- You move into a nursing home or other long-term care facility
- You move out of your current SNP coverage area
- Your SNP leaves the Medicare program
- You become eligible for Medicaid
Like other types of Medicare Advantage plans, Medicare SNPs will vary in terms of cost, coverage and availability from one location to the next.
How much does a Special Needs Plan cost?
Depending on the plan you have, a Special Needs Plan may include some of the following costs:
- Monthly premium
- Deductible
- Copayments or coinsurance
- Additional premiums or deductibles for prescription drug coverage (if required by the plan)
The costs tied to Special Needs Plans can vary significantly between one area, plan or insurance carrier to the next. Costs can also depend on whether or not you qualify for financial assistance or are eligible for Medicaid.
Read additional medicare costs guides to learn more about Medicare costs and how they will affect you.
How do I enroll in a Medicare SNP?
Call today to speak with a licensed insurance agent to review and compare Medicare Special Needs Plans, if you’re eligible for one in your area.
An agent can then help you review the details of each plan, including costs, coverage, network providers, terms, conditions and more so that you can make an informed decision about choosing a plan.
We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.
Learn more about Medicare enrollment
- How much does Medicare cost by state?
- Does Medicare cost change by income level?
- How do I cancel Medicare?
- What is Medicare Easy Pay?
- How do I enroll in a Medicare Advantage plan?
- What is a Special Enrollment Period?
- What is the average cost of Medicare?
- How does Medicare work with other forms of coverage?
- What is a 5-star Medicare Advantage plan?
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
