Special Needs Plans (SNP) are a type of Medicare Advantage Plan designed for Medicare beneficiaries with specific conditions or characteristics. For example, those with certain chronic medical conditions, living in a nursing home, or are eligible for both Medicare and Medicaid.[1][2][3][4][5][6]

There are three types of special needs plans based on conditions and characteristics:

  • Chronic Condition SNP (C-SNP): For beneficiaries with specific chronic conditions (see list below).
  • Institutional SNP (I-SNP): For beneficiaries who live in an institution, such as a long-term care (LTC) skilled nursing facility (SNF), a LTC nursing facility (NF), a SNF/NF, an intermediate care facility for individuals with intellectual disabilities (ICF/IDD), or an inpatient psychiatric facility.
  • Dual Eligible SNP (D-SNP): For beneficiaries enrolled in Medicare and Medicaid. This includes all categories of Medicaid.

SNPs not only limit membership based on specific conditions and characteristics, they have benefits, provider choices, and drug formularies based on those diseases and characteristics as well.

For example, one Special Needs plan may have benefits designed specifically to people with Cardiovascular disorders, another may have benefits designed to those with Chronic lung disorders, and another may have benefits focused on coordinating care in the community for those who require long-term care.

If you have one of the following chronic conditions you may qualify for a SNP based on a chronic condition:

  1. Chronic alcohol and other dependence
  2. Autoimmune disorders
  3. Cancer (excluding pre-cancer conditions)
  4. Cardiovascular disorders
  5. Chronic heart failure
  6. Dementia
  7. Diabetes mellitus
  8. End-stage liver disease
  9. End-Stage Renal Disease (ESRD) requiring dialysis (any mode of dialysis)
  10. Severe hematologic disorders
  11. HIV/AIDS
  12. Chronic lung disorders
  13. Chronic and disabling mental health conditions
  14. Neurologic disorders
  15. Stroke

To get a SNP you must have Part A and Part B and live in a plan’s service area.

Citations

  1. Special Needs Plan (SNP). Medicare.Gov.
  2. How Medicare Special Needs Plans (SNPs) Work. Medicare.Gov.
  3. How Medicare Special Needs Plans (SNPs) Work. Medicare.Gov.
  4. Institutional Special Needs Plans (I-SNPs). CMS.Gov.
  5. Dual Eligible Special Needs Plans (D-SNPs). CMS.Gov.
  6. Chronic Condition Special Needs Plans (C-SNPs). CMS.Gov.