Medicare Special Needs Plans (SNPs) are types of Medicare Advantage plans available to Americans with certain conditions, diseases, or characteristics. An SNP will typically provide enrollees with a network of doctors and specialists and specific benefits tailored to their group’s specific needs. Generally, your care will be handled by doctors and hospitals within this network, except in the cases of urgent or emergency care or if you have End-Stage Renal Disease and require out-of-area dialysis.
Since SNPs are Medicare Advantage plans, they cover everything Part C plans are required to cover. This gives the plans a good baseline coverage for your needs. SNPs are also required to cover prescription drugs.
There are three different types of SNPs, each with different focuses: Chronic Condition SNPs (C-SNPs), Dual Eligible SNPs (D-SNPs), and Institutional SNPs (I-SNPs).
In order to be eligible to join an SNP, you must meet certain requirements. First, you must have Original Medicare, Parts A and B. You must also live within the plan’s service area. Finally, you must qualify for one of the types of SNPs. There are three different types of SNPs, each with different focuses: Chronic Condition SNPs (C-SNPs), Dual Eligible SNPs (D-SNPs), and Institutional SNPs (I-SNPs).
C-SNPS are special needs plans available for people with specific severe or disabling chronic illnesses. Special needs individuals with severe or disabling chronic conditions are defined as individuals “who have one or more co-morbid and medically complex chronic conditions that are substantially disabling or life threatening; have a high risk of hospitalization or other significant adverse health outcomes; and require specialized delivery systems across domains of care.”
C-SNP plans cover 15 categories of chronic conditions. First on the list of approved conditions is chronic drug or alcohol dependence or addiction. Another group of conditions are a limited set of autoimmune disorders: polyarteritis nodosa, polymyalgia rheumatica, polymyositis, rheumatoid arthritis, and systemic lupus erythematosus.
C-SNPs cover 15 categories of chronic conditions — everything from addiction to cardiovascular disorders.
There are other larger conditions that are limited to specific diseases including cardiovascular disorders, severe hematologic disorders, chronic lung disorders, chronic and disabling mental health conditions, and neurologic disorders. Common illness like cancer, chronic heart failure, dementia, and end-stage renal disease are other major chronic conditions. Finally, diabetes mellitus, end-stage liver disease, and stroke round out the conditions.
According to the Centers for Medicare & Medicaid Services, a C-SNP plan’s specially-designed plan benefit package should include, but not be limited to:
- Supplemental health benefits specific to the designated chronic condition;
- Specialized provider networks specific to the designated chronic conditions; and,
- Appropriate enrollee cost sharing structured around the designated chronic conditions and co-morbidities for all Medicare-covered and supplemental benefits.
In simpler terms, each plan is tailored toward the specific condition it treats. So, a C-SNP plan for cancer will coordinate care among a network geared toward cancer treatment, with doctors who specialize in that field. This can give a fitting plan for your specific medical needs.
A Dual Eligible SNP (D-SNP) is available to seniors who are enrolled in both Medicare and Medicaid. D-SNPs use both Medicare and Medicaid to cover your medical costs. While individual states determine what a plan can cover, there are a few general expectations you can have. These are:
- Care coordination
- $0 monthly premiums
- Over-the-counter quarterly benefits
- Dental, vision, and hearing benefits
- Transportation benefits
- Gym memberships
- Telehealth services
- Special Enrollment Periods to switch D-SNPs monthly (limited to once a quarter beginning in 2019)
The type of D-SNP plan you’re eligible for depends on your Medicaid coverage.
Beyond this, the biggest difference is the type of D-SNP Medicare plan. The type of plan you’re eligible for depends on your Medicaid coverage. Within Medicaid, there are several categories an enrollee can fall under. These eligibility categories are full Medicaid only, Qualified Medicare Beneficiary (QMB) only, QMB Plus, Specified Low-Income Medicare Beneficiary (SLMB) only, SLMB Plus, Qualifying Individual (QI), and Qualified Disabled and Working Individual (QDWI). Plus plans are plans that use the eligibility category along with qualifying for full Medicaid benefits.
The final type of SNP Medicare plans are Institutional Special Needs Plans (I-SNPs). You’re eligible for an I-SNP if you need or are expected to need long-term care in a care facility for 90 days or more. These qualified care facilities include skilled nursing facilities, nursing homes, an amalgamation of the two, an intermediate care facility, or an inpatient psychiatric care facility. The I-SNP will cover many of your care costs associated with the specific institution you’re located.
The I-SNP will cover many of your care costs associated with the specific institution you’re located.
In order to enroll qualified citizens that require an institutional level of care, an I-SNP must fulfill two required conditions. First, there must be a method of determining institutional level of care based on state assessment tools. If the state doesn’t have a tool to use, the I-SNP must use the determination method from the state where the I-SNP is authorized to enroll. The other condition is that the I-SNP must have an independent third party administer the assessment. This third party cannot be owned or controlled by the I-SNP and must have the required knowledge to accurately determine a necessary institutional level of care.
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If you’re enrolled in Medicare, but have a special need that requires additional assistance, there may be an SNP designed for you. In order to join an SNP in your area, the plan must verify your special needs status.
If you’re interested in learning more about SNPs, what plans are available near you, and enrolling in one, check out the Medicareful Plan Finder tool. There you can see the D-SNPs available service your area and get in touch with a licensed agent who can guide you through the process.