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Medicare Special Needs Plans

Medicare Special Needs Plans (SNP) are a type of Medicare Advantage plan that is offered to those individuals with certain diseases, conditions or characteristics in order to provide coordinated care associated with these issues. For example, if a SNP recipient is enrolled in the plan due to a chronic lung disorder, the plan may include access to specialists that treat lung disorders as well as medications used to treat lung conditions. With respect to medications, all SNP plans include prescription drug coverage.

There are three different types of eligibility for a SNP. For an Institutional SNP (I-SNP), the enrollee must live in an institution or require nursing care in their home. For a Dual Eligible SNP (D-SNP), the beneficiary must be eligible for both Medicare and Medicaid. To qualify for a Chronic Condition SNP (C-SNP), the enrollee must have one or more of the following conditions:

  • Chronic alcohol and other drug dependence
  • Autoimmune disorders
  • Cancer (excluding pre-cancer conditions)
  • Cardiovascular disorders
  • Chronic heart failure
  • Dementia
  • Diabetes mellitus
  • End-stage liver disease
  • End-Stage Renal Disease (ESRD) requiring dialysis (any mode of dialysis)
  • Severe hematologic disorders
  • Chronic lung disorders
  • Chronic and disabling mental health conditions
  • Neurologic disorders
  • Stroke

Medicare SNPs are run by private insurance companies that have been approved by Medicare. Consumers that enroll in a SNP receive all of their Medicare hospital, medical health care services and prescription drug coverage through that health plan’s network of healthcare providers. Typically an enrollee in a SNP must choose a primary care physician and request referrals to see a specialist within the SNP’s network.

There are over 250 Special Needs Plans in the U.S. but they are not be available in every region. HealthPocket offers a Medicare Plan Comparison Tool where you can locate SNPs available in your area. The costs and fees associated with a SNP will vary but generally are about the same amount as a traditional Medicare Advantage plan.

SNPs may include the services of a care coordinator, someone who oversees all aspects of an enrollee’s health plan. This person may be responsible for seeing that patients receive both preventative care and specialist referrals. Other possible duties include streamlining the paperwork process or locating community resources such as support groups.

Consumers that are enrolled in a Special Needs Plan and lose their SNP eligibility receive a grace period of at least one month of coverage after their eligibility ends. During the grace period, they still receive medical coverage and enter a Special Enrollment Period in which they can choose another Medicare Plan, if eligible. The Special Enrollment Period lasts for two months after the SNP grace period ends.