Special needs plans (SNPs) are special types of Medicare Advantage plans tailored to certain populations with special health care needs. There are three types: Dual-Eligible SNPs, Chronic Condition SNPs and Institutional SNPs.
Each type of SNP covers added benefits and services specific to the population that qualifies for it, in addition to the same benefits as Medicare Part A and Part B.
Here’s what you should know about Medicare special needs plans.
What are the three types of Medicare special needs plans?
There are three types of Medicare special needs plans that serve different populations:
Each SNP type has its own rules for eligibility and benefits, and those rules can also vary by state and/or the health insurance company administering the plan.
What are the benefits of a Medicare special needs plan?
All SNPs include the same benefits covered by Medicare Part A and Part B, plus Medicare Part D prescription drug coverage.
Beyond those standard benefits, additional SNP benefits vary by plan type and health insurance company. Here are examples of benefits that each type could include:
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D-SNPs might cost little or nothing out of pocket and might offer help coordinating benefits between Medicare and Medicaid.
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Chronic Condition SNPs might offer special programs to help manage specific conditions or access to a provider network specializing in certain conditions.
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Institutional SNPs might help coordinate home-based, community-based and institution-based services.
There are also some potential drawbacks to SNPs. For example, your plan might deny services or charge more for out-of-network care, and you might need to get referrals to see specialists.
When shopping, check the plan materials for the specifics to be sure you can get the care you need within the applicable limitations.
How do you qualify for a Medicare special needs plan?
To qualify for an SNP, you must have both Medicare Part A and Medicare Part B, live in the plan’s service area and meet the type-specific requirements.
Each type of SNP has its own eligibility requirements:
Dual-Eligible SNPs
People who qualify for both Medicare and Medicaid are eligible to join a D-SNP.
Medicaid eligibility is mostly based on income, but it’s also possible to qualify for other reasons, such as receiving Supplemental Security Income (SSI).
States’ Medicaid eligibility rules vary. You can review the criteria for your state on Medicaid.gov.
Chronic Condition SNPs
People with certain medical conditions are eligible to join a Chronic Condition SNP.
There are qualifying conditions in categories including, for example, autoimmune disorders, cancer, cardiovascular disease, end-stage renal disease (ESRD), HIV/AIDS, mental health conditions and neurologic disorders.
You can see the full list of qualifying chronic conditions on Medicare.gov.
Institutional SNPs
People who have had or are expected to need certain institutional-level care for 90 days or more are eligible to join an Institutional SNP.
Examples of qualifying institutions include nursing homes, skilled nursing facilities, long-term care hospitals and psychiatric hospitals.
It’s also possible to qualify for an Institutional SNP if you’re living in the community (not in a facility), but you need facility-level care. There are state-specific assessments to determine eligibility in these circumstances.
What do Medicare special needs plans cost?
Premiums for Medicare special needs plans vary by plan type and health insurance company. Here’s what you can expect to pay with each type of SNP:
You’ll generally still be responsible for the Medicare Part B premium, which is $174.70 per month in 2024, unless your plan or another program covers some or all of that cost for you.
Other costs such as deductibles, coinsurance and copays are also plan-specific. You can find cost breakdowns in plan materials or compare costs when shopping for SNPs on Medicare’s plan finding tool. (Start by searching for Medicare Advantage plans, then select “View all filters” and check the box to show one or more types of SNPs.)
