Medicare Special Needs Plans, or SNPs, are a type of Medicare Advantage Plan for those who meet certain conditions. They generally provide coverage for doctor visits, hospital services, and prescription drugs. To qualify for a Special Needs Plan, you must first have Original Medicare (Part A and Part B) and you must live within the service area of a SNP plan.
All SNPs will have a provider network (just like any other plan). That means that you must visit a doctor, pharmacy, and hospital that is in your plan’s network. You will also have to select either a primary care physician or a health coordinator. The only exception is if you have End-Stage Renal Disease and need to see an out-of-network specialist for dialysis or if you have an urgent medical emergency and need to get to the nearest emergency room or urgent care facility.
There are three main types of special needs plans – C-SNPs, I-SNPs and D-SNPs.
If you are eligible for both Medicare and Medicaid, you can enroll in a D-SNP. In this case, most of your costs will be covered for you.
I-SNPs are for those who live in an institution like a skilled-care facility or nursing home and for those who have a nurse helping at home.
C-SNPs are generally designed for specific types of illnesses and disabilities. For example, a Chronic Condition Special Needs Plan for someone with chronic heart failure may provide extra coverage for heart treatments, while a C-SNP for someone with chronic substance abuse may provide extra coverage for therapy and rehabilitation.
To qualify for a C-SNP plan, you must have a qualifying disabling condition. Medicare.gov lists qualifying conditions as:
- Chronic alcohol or other substance abuse
- Autoimmune disorders
- Cancer and precancerous conditions
- Cardiovascular disorders
- Chronic heart failure
- ESRD (End-Stage Renal Disease) or End-Stage Liver Disease
- Severe hematologic disorders
- Chronic lung disorders
- Chronic and disabling mental health conditions
- Neurological disorders