What are Medicare Special Needs Plans (SNPs)?

There are 3 types of special needs plans. Each includes all the benefits of Original Medicare Part A and Part B plus coverage for prescription drugs. 

Let’s take a closer look. 

Chronic Condition Special Needs Plans (C-SNPs)

Chronic Condition Special Needs Plans (C-SNPs)  offer special care for people who are dealing with certain chronic health conditions. In addition, care coordinators are assigned to help members get the right care to address their specific health issues. 

How do I qualify for a C-SNP?

First, you need to have Medicare Part A and Part B. You must also have 1 or more qualifying chronic health conditions. These conditions are set by the Centers for Medicare and Medicaid (CMS) and must be verified by a doctor within 60 days of enrolling in a C-SNP. Conditions may include:

• Chronic alcohol and other dependence
• Certain autoimmune disorders 
• Cancer (excluding pre-cancer conditions)
• Certain cardiovascular disorders
• Chronic heart failure
• Dementia 
• Diabetes mellitus
• End-stage liver disease
• End-stage renal disease (ESRD) requiring dialysis 
• Certain severe hematologic disorders 
• HIV/AIDS
• Certain chronic lung disorders
• Certain chronic and disabling mental health conditions
• Certain neurologic disorders 
• Stroke

Dual-Eligible Special Needs Plans (D-SNPs)

Dual-Eligible Special Needs Plans (D-SNPs)  are for people who have both Medicare and Medicaid. D-SNPs offer a broad range of benefits with low or no out-of-pocket costs for our low income members. All D-SNPs include coverage for prescription drugs. Most also include coverage for routine dental, vision and hearing care. 

How do I qualify for a D-SNP? 

First, you must be eligible for Medicare. You must also meet the specific Medicaid requirements in your state of residence. With a D-SNP, your Medicare and Medicaid benefits are combined into 1 easy-to-manage plan.

Institutional Special Needs plans (I-SNPs)

Institutional Special Needs plans (I-SNPs)  are Medicare Advantage plans for people in a nursing home or who need that same kind of care at home.

How do I qualify for an I-SNP?

You can enroll or disenroll year-round in an I-SNP. There is no need to wait for the Annual Enrollment Period. To qualify for an I-SNP, you must live (or be expected to live) in 1 of the following for at least 90 days in a row:

• Nursing home
• Intermediate care facility
• Skilled nursing facility
• Rehabilitation hospital
• Long-term care hospital
• Psychiatric hospital
• Other facility that offers similar long-term, healthcare services 

How much does a Special Needs Plan (SNP) cost?

Monthly premiums vary by plan and by location.

C-SNP and I-SNP members must continue to pay their Part B premiums. If you qualify for a D-SNP, most of your plan costs, including your Part B premium, will be covered by your plan. 

As with other Medicare Advantage plans, SNPs may require that you  choose doctors and care facilities in the plan’s network. Some SNPs may offer coverage for out-of-network providers, but you’ll usually pay more. You can use our Find Care tool  to find providers in your plan’s network. 

How do I enroll in a Special Needs plan (SNP)?

Every year from Oct. 15 to Dec. 7, you can join, switch, or drop your Medicare plan. This is called the Annual Enrollment Period (AEP) .

Did your health or your financial situation change during your plan year? If you become eligible for a SNP outside of the Annual Enrollment Period, you may be able to join a SNP right away during a Special Enrollment Period (SEP) . A Medicare SEP is a period of time to enroll or change a Medicare Advantage plan outside of Medicare’s AEP. 

Here are a few examples of SEPs that may apply:

• Chronic Condition (C-SNP): If you get a new, qualifying chronic condition, you may qualify for an SEP to join a C-SNP.
• Dual Eligibility (D-SNP): SEPs may be available for people who become eligible for both Medicare and Medicaid outside of Medicare’s Annual Enrollment Period.
• Institutional (I-SNP): If you've lived in a nursing home or similar facility for 90+ days, you may qualify for an SEP. 

Special plans to meet special needs

Special Needs Plans provide extra services to help meet the unique needs of the people they serve. 

If you have a certain long-term illness, live in a care facility, or have both Medicare and Medicaid, a Special Needs Plan could be a great way to get the extra care you need to achieve your best health.