Medicare Advantage SNP Plans
Fact checkedContributing expert: Roseann Birch, insurance consultant; Reviewed by: Leron Moore, Medicare consultant - Updated: Jan 12, 2022
Learn about types and eligibility requirements of Special Needs Plans (SNPs) that may be available to you.
What You Should Know
- 1 Since their introduction in 2003, Medicare Advantage Special Needs Plans (SNPs) have been offered to seniors with care needs that exceed the type and scope offered under Original Medicare.
- 2 As an alternative to Original Medicare Parts A and B and Part D, Medicare SNPs combine everything into a single plan.
- 3 In addition to the comprehensive coverage for hospitalization, medical services, and prescription drugs, these plans also offer coverage not typically available through Original Medicare.
- 4 SNPs can offer customized healthcare packages and easier access to care for some illnesses, but not every plan is available in every area.
The Medicare Special Needs Plan is an option under Medicare Advantage designed for those with chronic health conditions who may need extra help. For instance, Original Medicare doesn’t always cover extended-care stays in institutions or hospitals, but this type of care may be covered with an SNP. To qualify, you must have an SNP provider in your area, and your medical diagnosis must meet the enrollment criteria.
Read on for more information about SNPs and their eligibility requirements.
What is a Medicare SNP Plan?
SNPs, a type of Medicare Advantage plan, were introduced in 2003. Since their introduction, Medicare SNPs have been offered to seniors with care needs that exceed the type and scope offered under Original Medicare.
Medicare Advantage plans combine Parts A and B to create a single, more extensive healthcare coverage option. All Advantage plans must cover everything offered through Original Medicare, with the exception of hospice care. Most plans also incorporate some form of Medicare Part D, which provides prescription drug coverage.
Advantages of a Medicare SNP
Medicare SNPs offer coverage tailored to meet the needs of seniors with more complicated medical conditions. These plans are broken down into three types:
- Chronic Condition Special Needs (C-SNP)
- Institutional Special Needs (I-SNP)
- Dual Eligible SNP (D-SNP)
In addition to the comprehensive coverage for hospitalization, medical services, and prescription drugs, these plans also offer coverage not typically available through Original Medicare. For example, an I-SNP is designed for those who need a long-term stay in a nursing home, assisted living community, or hospital. Original Medicare only covers 90 days in one of these care settings, but an I-SNP offers more extended options for those who need it.
A C-SNP might offer prescription drug plans with lower copays on the most commonly used medications to treat an illness. D-SNPs combine the coverage provided by Medicare and Medicaid to create a more affordable all-in-one solution with helpful care coordination.
Disadvantages of a Medicare SNP
Not all Medicare-eligible seniors will qualify for one of the available plans. Enrolling can be difficult, since it may require documentation from a medical professional.
While an SNP can offer customized healthcare packages and easier access to care for some illnesses, not every plan is available in every area. SNPs also offer more limited access to healthcare professionals, since providers must be in-network. Be sure to discuss your specific medical needs with the insurance provider before selecting an SNP.
Who is eligible for a Medicare SNP?
Seniors interested in an SNP must be currently enrolled in both Medicare Part A and B. SNPs are not offered in all states, so there is also a location requirement.
You must be 65 or older and already enrolled in Medicare to apply for an SNP. You must also qualify for one of the three types of SNP options.
- If you have a chronic health condition, such as congestive heart failure, addiction, dementia, diabetes, HIV/AIDS, end-stage renal disease or similar illnesses, C-SNP plans may be an option for you.
- If you currently reside in a nursing home or other institutional setting and need to remain for longer than 90 days, you may qualify for an I-SNP.
- If you are dually eligible for Medicaid andMedicare, you may qualify for a D-SNP.
Ultimately, eligibility often depends on availability and whether providers have a plan specific to your needs.
How much does a Medicare SNP cost?
SNPs roll all the Medicare parts into a single premium, and the cost varies depending on the plan and the copay amounts. Take a look at the plan documents, and pay particular attention to information about out-of-pocket costs and limits, to get a better idea of the total amount you can expect to pay.
Often, SNP providers are limited in what they can charge for covered services, so the individual items billed are typically within the amounts allowed by Medicare. Overall, the cost of an SNP should be close to what you would expect to pay for a Medicare Advantage plan. If you have a D-SNP, however, most of your healthcare costs will be covered.
How do I enroll in a Medicare SNP?
If you’re interested in an SNP program, you can apply online or call Medicare at 1-800-633-4227 for more information. Check to see if there is an SNP available in your area. Each type of SNP plan has specific enrollment requirements.
- C-SNP: When applying for C-SNP, you must include a note from your doctor stating your diagnosis, which must be on the list of covered conditions.
- I-SNP: If you are interested in an I-SNP, you must have exceeded a 90-day stay in an approved long-term care facility, or have a medical necessity for a nursing home’s higher level of care.
- D-SNP: Dual eligibility plans require documentation that you’ve been approved for Medicaid. A copy of an approval letter or insurance card is often enough.
As long as you meet eligibility requirements, you can join an SNP anytime. If you no longer meet criteria, you will be able to switch to a different health plan.
Who should get a Medicare SNP Plan?
Medicare SNPs are not available to everyone. If you meet eligibility requirements, you may want to explore the potential benefits of switching to an SNP for improved service and care coordination.
If you are currently enrolled in a Medicare Advantage Plan with little to no out-of-pocket costs, and if you are satisfied with your services, you may not need to join an SNP.
Medicare has strict limits on the number of annual days you can stay in the hospital or a nursing home. I-SNPs extend those benefits if you need longer-term institutionalization. A C-SNP offers more focused treatment and specific medication coverage if you have a chronic illness. If you are dual-eligible for Medicare and Medicaid, a D-SNP offers better care coordination and lowest possible costs.
- Featured Sources [-]
CMS:SNP Application | Last accessed January 2022
Medicaid: The Official Government Site for Medicaid | Last accessed January 2022
Medicare: Medicare Advantage Plans | Last accessed January 2022
Medicare: Home Sign up/change plans Special Needs Plans (SNP) | Last accessed January 2022
Medicare: Joining a health or drug plan | Last accessed January 2022
Medicare: How Special Needs Plans (SNPs) Work | Last accessed January 2022
Medicare: Find a 2022 Medicare plan | Last accessed January 2022
Roseann Birch, Medicare Consultant
With experience in the insurance field since 1986, Roseann Birch is a seasoned Medicare consultant who is passionate in educating and guiding seniors through their Medicare and Medicare Advantage journey.
Leron Moore, Medicare Consultant
With over 10 years of experience in the Medicare industry, Leron Moore has dedicated his career to effecting change, educating, informing, and resolving issues for Medicare patients and their families.