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Understanding Medicare Advantage Special Needs Plans (SNPs)

October 6, 2016

Medicare beneficiaries enrolled in Original Medicare, Part A and Part B, have various Medicare plan options (through Medicare-approved private insurance companies) with Medicare Advantage (Medicare Part C). One such option is a Medicare Special Needs Plan (SNP), which is exclusively designed for individuals with specialized health needs.

Medicare Advantage overview

Medicare Advantage plans are required by law to offer at least the same benefits as Original Medicare, Part A and Part B. As such, Medicare beneficiaries may enroll in a Medicare Advantage plan as an alternative way to receive their Original Medicare benefits (except for hospice care, which is still provided by Part A). Medicare Advantage plans cover all hospitalization and medical benefits offered by Original Medicare, and may offer additional benefits, like vision, hearing, and dental, depending on which specific plan you choose and which plan is available in your local service area. Please note that generally, you’ll still need to pay your Medicare Part B premium, along with any premium the Medicare Advantage plan requires, as well as copayments, coinsurance, and deductibles.

What is a Medicare Advantage Special Needs Plan?

A Special Needs Plan (SNP) is a type of Medicare Advantage plan that generally limits enrollment to people with certain health conditions or characteristics and customizes the plan’s coverage to better serve the specific needs of the groups they serve. To join a Medicare Advantage SNP, you must be enrolled in Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), meet the additional eligibility criteria as required by the plan, and you must reside in the particular plan’s service area.

All Medicare Advantage SNPs are required to offer the same basic benefits that are covered by Original Medicare and available from all Medicare Advantage plans. They may also offer special benefits customized to the particular group they serve.

There are three types of SNPs available. A Chronic Care SNP focuses on providing coverage to individuals who have been diagnosed with a specific chronic condition such as diabetes mellitus, hypertension or End Stage Renal Disease (ESRD).  To enroll in a Chronic Care SNP, you must have the applicable chronic condition.  For example, to enroll in a Diabetic Chronic Care SNP plan, you must have been diagnosed with diabetes mellitus.

The two additional types of SNPs are the Institutional SNP, which is for Medicare beneficiaries living in either an institution like a nursing home or requiring at-home care, and the Dual Eligible SNP for those enrolled in both Medicare and Medicaid.

Availability and costs of Medicare Advantage SNPs

Medicare Advantage Special Needs Plans (SNPs) are available in certain parts of the United States, depending on where insurance companies decide to offer them. SNPs may be available in certain counties of a particular state, and there may be various plan options available in a single county, each with different benefits and costs. Insurance companies offering Medicare Advantage SNPs have the right to leave Medicare each year.  If you are a member of a Special Needs Plan that decides to discontinue their contract with Medicare, you will receive a letter from the plan.  You will also be given a Special Election Period to enroll into a new plan.

Note that you can only remain enrolled in the specific Medicare Advantage Special Needs Plan you choose as long as you are eligible for the situation that the plan covers, such as having a chronic illness, living in an institution, or qualifying for Medicaid.