A Medicare Special Needs Plan (SNP) is a kind of Medicare Advantage Plan that offers special benefits for people who meet its eligibility criteria. All Medicare Advantage Plans are offered by private companies contracting with Medicare. Different kinds of special needs plans are available depending on where you live. For instance, Humana offers an SNP plan for those with diabetes who live in Florida.
Depending on your income and other benefits you are eligible for, as well as the availability of other Medicare Advantage Plans in your area, a Medicare SNP may be a good choice for your health care (see more on the benefits of SNPs below). However, choosing a Medicare Advantage plan is complicated, so you should study all of the plans available in your area and consider which is the best for you.
Medicare rules limit who can enroll in an SNP. Only those who are eligible for Medicare Part A and Part B can join an SNP. (You sign up for a Medicare Advantage Plan instead of getting Medicare Part A and B straight from the government. Medicare Advantage is often referred to as Medicare Part C.) Folks eligible for Medicare Parts A and B include seniors over 65 and persons with disabilities who are collecting SSDI (Social Security disability insurance).
Also, you must either have a chronic condition, be eligible for Medicaid (and Medicare), or need institutional-level care to be eligible for an SNP.
Medicare allows private companies to offer SNPs to Medicare beneficiaries who suffer from particular chronic and disabling conditions. Those SNPs are called chronic condition SNPs (or C-SNPs). In 2013, the conditions that make a person eligible for a chronic condition SNP are:
Even if you have one of the conditions on this list, you must check to see whether an SNP for your condition is offered where you live. C-SNPs are not required to cover all fifteen conditions, and many are limited to one or a few conditions on the list.
Low-income seniors and low-income people who are severely disabled can be eligible for Medicaid and Medicare at the same time. These folks are called "dual-eligibles." In some situations, Medicaid can pay all of the out-of-pocket health care costs for a dual-eligible Medicare beneficiary.
If you are eligible for both Medicare and Medicaid, then you could be eligible for a particular kind of SNP called a dual-eligible SNP (D-SNP). Private companies that offer D-SNPs are permitted to restrict them to certain categories of dual-eligible beneficiaries, so check to see if you might be eligible for a D-SNP in your area. Dual-eligible SNPs are the most common kind of special needs plan.
Medicare beneficiaries who live in institutions or need institutional levels of care in their homes can be eligible for institutional SNPs (I-SNPs). Medicare allows private companies to offer I-SNPs to Medicare beneficiaries who have been in an institution for 90 days or who are expected to need institutional level care for at least 90 days. Institutions include long-term care facilities offering skilled nursing services, intermediate care facilities for individuals with intellectual disabilities, and inpatient psychiatric facilities.
SNPs are marketed to people with particular conditions and offer benefits that might appeal to those people. For example, a private company might offer an SNP for people with diabetes, and the plan benefits might include more coverage for the best medications used to treat diabetes, a network of doctors who specialize in diabetes treatment, and more preventative care than might be available from other Medicare Advantage plans in the same location.
An SNP for dual-eligible individuals might offer the services of a care coordinator, a person whose job it is to help the beneficiary find appropriate services in her community.
A Medicare special needs plan can make sense for those with a permanent disability, folks with chronic or multiple conditions such as diabetes, or diabetes and cardiovascular problems, and elderly people with dementia who need institutional care. Many people are able to drop their medi-gap policies when they join a special needs plan because their special needs plan fills in the gaps not covered by traditional Part A and B Medicare.
Medicare rules restrict the time that a person can apply for any Medicare plan, including an SNP. A new Medicare beneficiary can join an SNP anytime during the initial enrollment period. If you are eligible for Medicare because of your age, the initial enrollment period is a seven-month period around your 65th birthday. If you are eligible for Medicare because of your disability, the initial enrollment period is a seven-month period around your 25th month of disability.
Once you are enrolled in an SNP plan, you can switch plans only between October 15th and December 7th of every year. There are a few exceptions to that rule, however. If you are newly diagnosed with a condition that makes you eligible for an SNP, then you can switch to an SNP regardless of whether it is the open enrollment period. If you move out of your SNP’s service area, you can also switch plans, regardless of the timing.
You can see what Medicare Advantage plans, including SNPs, are available in your area, by using this online Medicare Plan Finder at medicare.gov. However, there are many Medicare plans available, and it can be confusing to choose the best one for you.
Fortunately, every state has a State Health Insurance Assistance Program (SHIP) that can provide individualized counseling to you about the different Medicare Advantage plans available and how much you could expect to pay under a particular plan, based on your expected health needs and medications. Most often, a state’s SHIP is part of its agency serving seniors and disabled individuals. To find the SHIP in your state, use the SHIP Resource Center.
You can also find out what plans are available to you and get the contact information for your local SHIP by calling Medicare at 800-MEDICARE or looking in the back of the “Medicare & You” handbook that should be mailed to you each fall. You can find more information about Medicare SNPs in Medicare's Guide to SNPs.