What is a Medicare Advantage Special Needs Plan?

Reviewed and Updated by Anastasia Iliou,

A Medicare Advantage Special Needs Plan, or SNP, is a Medicare Advantage plan that is designed to provide coordinated care for Medicare beneficiaries with special needs. These plans have specific qualifications but offer expanded and specialized coverage.

Medicare Advantage SNPs are specific to your needs whether that be diabetes, Alzheimer’s, heart disease, or another chronic illness. Plus, all SNPs must include hospital coverage (Part A), medical coverage (Part B), and prescription drug coverage (Part D). Other benefits include $0 or lower beneficiary cost sharing, extended benefits coverage for inpatient care, and longer coverage periods for specialty medical services.

Like all healthcare plans, SNPs have provider networks. In most cases, you will need to select a primary care physician or health coordinator to be your main source of healthcare.

Medicare Advantage Special Needs Plan Eligibility

To start, you’ll need to be enrolled in Original Medicare. You also must live in an area that supports a SNP plan as they are not available everywhere. Then, to be eligible, you must have a special need. In the case of SNPs, special needs can mean Medicaid-eligible/low-income (D-SNP), institutionalized (I-SNP), or diagnosed with a severe or disabling chronic condition (C-SNP).

What is a dual eligible special needs plan (DSNP)?

The “dual” in Dual Special Needs Plan indicates that you are eligible for both Medicare and Medicaid. If you are over the age of 65 and have low income, there is a good chance that you fall into the D-SNP category! If you are eligible, most of your costs will be covered for you. To learn more about the Medicaid eligibility categories that could place you in a DSNP plan, click here.

What is an Institutional Special Needs Plan (ISNP)?

To be eligible for an I-SNP, you must live in or be moving into a long-term care skilled nursing facility, inpatient psychiatric facility, or another care facility. You must require the facility’s services for at least 90 days to qualify for an I-SNP.

What is a Chronic Condition Special Needs Plan (CSNP)?

CSNPs 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 additional coverage for heart treatments, while a CSNP for someone with chronic substance abuse may offer extra coverage for therapy and rehabilitation. Qualifying conditions can include chronic alcohol or other substance abuse, neurological disorders, heart failure, and more.

How to Enroll in a Medicare Advantage Special Needs Plan

If you are eligible for a Medicare Advantage special needs plan, you are eligible for a Special Enrollment Period. This is great because you can enroll any time of year and don’t need to wait for a specific enrollment period! If you are looking to enroll in a Medicare Advantage Special Needs Plan in your area, a licensed agent can guide you through the process. In fact, our agents at Medicare Plan Finder can answer any questions about SNPs and eligibility. There is no cost to you and never an obligation to enroll. To get in contact, fill out this form or call us at 844-431-1832.

This blog was originally published on 6/14/18, but was updated on 3/22/19.

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