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A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage plan (Medicare Part C) that is designed to fit the health care needs of people with a certain health condition or circumstance.
Medicare SNP benefits, provider choices and drug formularies are all designed specifically to serve a beneficiary who meets the specific criteria of that plan.
Special Needs Plans are a type of Medicare Advantage plan.
Medicare Advantage plans are a form of private Medicare coverage. These plans, sold by private insurance companies, offer all the same benefits as Original Medicare (Part A and Part B).
Many Medicare Advantage plans also offer some additional coverage, which may include coverage for dental, vision, hearing, prescription drugs and more.
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Keep in mind, Special Needs Plans may not be available where you live.
In order to qualify for a Special Needs Plan, you must meet each of the following criteria:
A Chronic Condition SNP will require a note from your doctor confirming your diagnosis.
An Institutional SNP requires residence in a long-term care facility for at least 90 days or home nursing care for 90 days or more.
Special Needs Plans are sold by private insurance companies, so plan selection may vary from one location and carrier to the next.
As of May 2019, there are a total of 734 Special Needs Plans available throughout the U.S.1 The breakdown of those plans is as follows:
Availability depends on where you live. Not all states or areas have SNP plans.
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If you are Medicare dual-eligible, some of the costs to join a D-SNP (such as premiums and deductibles) may be covered for you.
For other Special Needs Plans, your costs might vary but may include a monthly premium, deductible and coinsurance or copayments.
Some Medicare Special Needs Plans utilize a “care coordinator.”
A care coordinator is a type of personal health care assistant who helps you schedule appointments, adhere to your doctor-recommended diet and exercise plan, obtain the right prescriptions, access community resources and more.
Most Special Needs Plans will require you to have a primary care physician (PCP) who must issue you a referral before seeing a specialist.
Typically, you must remain in the plan’s network of providers to receive care, except in the case of emergency or urgent care, or for those with End-Stage Renal Disease (ESRD) seeking out-of-area dialysis.
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Like all Medicare Advantage plans, Special Needs Plans will provide all of the same coverage as Medicare Part A and Part B.
Additionally, Special Needs Plans may feature a custom set of benefits designed specifically for the needs of the beneficiary.
All Medicare Special Needs Plans include prescription drug coverage.
You may join a Medicare Special Needs Plan during the same enrollment periods used for standard Medicare Advantage plans.
These enrollment periods include:
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You can learn more about Medicare Special Needs Plans by visiting MedicareAdvantage.com.
1 CMS. SNP Comprehensive Report (PDF). Retrieved June, 2019, from www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData/Special-Needs-Plan-SNP-Data-Items/SNP-Comprehensive-Report-2019-05.html.
Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareSupplement.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
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