Medicare Advantage SNP Plans
Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Published: September 14, 2020
What You Should Know
- 1 Since their introduction, Medicare SNPs have been offered to seniors with care needs that exceed the type and scope offered under Original Medicare.
- 2 Instead of Parts A, B and 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 While an SNP plan can offer customized healthcare packages and easier access to care for some illnesses, 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. Original Medicare doesn’t always cover extended-care stays in institutions or hospitals, but this type of care may be covered with an SNP plan. To qualify, you must have an SNP plan provider in your area, and your medical diagnosis must meet the enrollment criteria. Read on for more information about SNP plans and their eligibility requirements.
What is a Medicare SNP Plan?
SNPs, a variety of Medicare Advantage plans, 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 Plan
Medicare SNP plans 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-SNP plans combine the coverage provided by Medicare and Medicaid to create a more affordable all-in-one solution.
Disadvantages of a Medicare SNP Plan
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 plan 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 Plan?
Seniors interested in an SNP plan 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.
In general, a senior must be 65 or older and already enrolled in Medicare to apply for an SNP Plan. Seniors must also qualify for one of the three types of SNP plan options.
- For those with chronic health conditions such as congestive heart failure, addiction, dementia, diabetes, HIV/AIDS, end-stage renal disease or similar illnesses, C-SNP plans may be an option.
- Seniors who currently reside in a nursing home or other institutional setting and need to remain for longer than 90 days may qualify for an I-SNP.
- A Medicaid-eligible senior who also has Medicare may qualify for a D-SNP.
Ultimately, eligibility often depends on availability and whether providers have a plan specific to a senior’s needs.
How much does a Medicare SNP Plan cost?
SNP plans 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.
How do I enroll in a Medicare SNP Plan?
If you’re interested in an SNP program, you can apply online or call Medicare at 1-800-633-4227 for more information. 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: A senior interested in an I-SNP plan 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. However, you will need to apply to an SNP during Medicare Advantage enrollment periods or during a special enrollment period.
A recent change in healthcare needs often triggers a special enrollment period, allowing you to apply for SNP enrollment if desired. Any senior with a debilitating, chronic illness is always eligible to switch to an SNP plan.
Who should get a Medicare SNP Plan?
Medicare SNP plans are not available to everyone. Since enrollment is limited, any senior who qualifies may want to explore the potential benefits of switching to an SNP.
Seniors currently enrolled in Medicare Parts A and B and an Advantage Plan with little to no out-of-pocket costs may not need to switch. Those faced with rising healthcare costs and changes to their health may benefit from combining all of their service needs into a single plan. Original Medicare has strict limits on the number of annual days a member can stay in the hospital or a nursing home. SNP plans extend those benefits for those at higher risk of longer-term institutionalization.
- Sources [-]
https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans/SNP-Application, last accessed September 2020.
https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans, last accessed September 2020.
https://www.medicare.gov/eligibilitypremiumcalc/, last accessed September 2020.
https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap, last accessed September 2020.
https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/special-needs-plans-snp, last accessed September 2020.
https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan, last accessed September 2020.
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.