Medicare Special Needs Plans, also called SNPs, are similar to Medicare Advantage plans, however, they are only open to people with specific diseases or certain characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the distinct needs of the groups they serve so that these plans can better serve those with unique needs.
There are 3 types of Special Needs Plans available:
- Chronic-Condition Special Needs Plans (C-SNP): These types of plans serve beneficiaries with certain severe or disabling chronic conditions such as dementia, chronic health failure, or HIV/AIDS. Chronic-Condition Special needs plans may target either a single chronic condition or more than one condition.
- Institutional Special Needs Plans (I-SNP): These plans serve who are living in an institution such as a nursing home, or who need nursing care at home.
- Dual-Eligible Special Needs Plans (D-SNP): These plans serve people who have both Medicare and Medicaid benefits (also known as “dual eligibles”).
If you fall into any one of these categories, you may have a unique health-care need that an SNP may be better equipped to address. For example, some Special Needs Plans offer a larger network of providers that specialize in treating your condition. Or they may have formularies that are tailored to cover the prescription drugs typically prescribed for your particular illness.
To be eligible to enroll in a Medicare SNP you must meet some requirements. You must:
- Be enrolled in Original Medicare (Part A and Part B)
- Live in the service area of the Special Needs Plan.
- You must meet the eligibility requirements that the Special Needs Plan targets, such as having both Medicare and Medicaid, being institutionalized, or having chronic conditions covered by the plan.
- Medicare beneficiaries with end-stage renal disease are typically not allowed to enroll in a MA plan, with some exceptions. However, if there is a Special Needs Plan that targets ESRD beneficiaries in your service area, you may be eligible to enroll in this type of plan.
It’s important to note that you still get all the coverage that is otherwise included with Original Medicare, Part A, and Part B, and Part D. The Special Needs Plan simply offers extra coverage to help you better manage your particular situation.
One key difference between a Special Needs Plan and other types of Medicare Advantage plans is that all Special Needs Plans must cover prescription drugs. In contrast, other Medicare Advantage plans may or may not include prescription drug coverage, it all depends on the specific plan.