Medicare Advantage Special Needs Plans (SNPs)

Steven Mott by Steven Mott | Licensed since 2012
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This article was updated on: 09/15/2018

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A Medicare Advantage Special Needs Plan, also known as a SNP, is a Medicare Advantage plan that is exclusively designed for individuals with specialized health needs. Some of those needs include:

  • A chronic or disabling health condition (e.g., diabetes, end-stage renal disease (ESRD), HIV/AIDS, chronic heart failure, or dementia)
  • Simultaneous enrollment in Medicaid and Medicare (also known as dual eligible)
  • Residence in certain institutions such as a nursing home

Special Needs Plans are Medicare Advantage plans, meaning that both Medicare Part A (hospital) and Part B (medical) benefits are provided through the plan (except for hospice benefits, which Part A still covers). Unlike most Medicare Advantage plans, which may or may not include prescription drug benefits, all Special Needs Plans must include prescription drug coverage .

SNPs are designed specifically to treat the qualifying illness or situation. This means that Special Needs Plans tailor plan benefits, health-care providers, and prescription drug coverage to meet the specific needs associated with the plan.

When enrolled in a Special Needs Plan, the beneficiary must continue paying the Medicare Part B premium, as well as the monthly premium for the Special Needs Plan.

Eligibility for Medicare Special Needs Plans

To qualify for a Special Needs Plan, typically you must:

  • Be enrolled in Medicare Part A and Part B.
  • Reside in the plan’s coverage region.
  • Satisfy the Special Needs Plan’s enrollment criteria (e.g., have the specific qualifying medical condition associated with the plan; live in an institution; or be enrolled in both Medicare and Medicaid)

A Chronic Condition Special Needs Plan is designed to help plan members follow doctors’ instructions related to diet and prescription drug use. Plans targeting people simultaneously enrolled in Medicare and Medicaid, known as Dual Eligible Special Needs Plans, may assist with the coordination of Medicare and Medicaid services. Institutional Special Needs Plans target the unique needs of those living in nursing homes and other institutions.

There are Chronic Condition Special Needs Plans available for the following conditions. Keep in mind that not every plan may be available in every region. You must have one or more than one of the following conditions:

  • Chronic alcohol or drug dependence
  • Certain autoimmune disorders
  • Cancer
  • Certain cardiovascular disorders
  • Chronic heart failure
  • Dementia
  • Diabetes
  • End-stage liver disease
  • End-stage renal disease (kidney failure that requires dialysis or a kidney transplant)
  • HIV/AIDS
  • Certain chronic lung conditions, including asthma and emphysema
  • Stroke
  • Certain disabling mental health conditions, such as bipolar disorder, schizophrenia, and paranoid disorder
  • Neurological disorders, including epilepsy, amyotrophic lateral sclerosis, multiple sclerosis, Parkinson’s disease, and Huntington’s disease

Please note: The list above doesn’t necessarily include every chronic condition that might qualify you for an SNP. If you have a chronic health condition not listed above, you might want to contact Medicare to ask whether you’d qualify for an SNP. Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Medicare representatives are available 24 hours a day, seven days a week.

If you have a chronic or debilitating condition, a Chronic Condition Special Needs Plan can help your doctors and providers better coordinate your care. For example, a Special Needs Plan for HIV/AIDS patients might help members understand the side effects of medications or give advice on how to discuss their condition with loved ones. A Special Needs Plan for members with mental health conditions would coordinate with all of the medical professionals involved in treatment, from psychiatrists, psychologists, physicians, nurses, social workers, and other health-care professionals.

Special Needs Plans can be a good option for people with unique health needs. If you’d like more information about whether a Special Needs Plan might work for you or a loved one, just let me know If you’d prefer to speak one-on-one, I can give you a call or email you some more information; just use the links below to do that. If you’d like to browse plans right now, you can always use the Find Plans button on this page.

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