Special Needs Plans

Special Needs Plans (SNPs) are a type of Medicare Advantage plan designed for people that meet certain criteria. There are Chronic Condition SNPs (C-SNPs), Institutional SNPs (I-SNPs), and Dual Eligible SNPs (D-SNPs). 

Each plan is intended to cater to the specific needs of its members. You can remain under the SNP plan until you no longer meet the conditions served by the plan (such as losing Medicaid eligibility).

All SNPs offer prescription drug coverage in addition to the standard Medicare coverage for Part A and Part B. Some may offer additional benefits such as extra days in the hospital. Like most Medicare Advantage plans, these plans have certain requirements which may include having a primary care physician or a care coordinator. Care coordinators are people who help you get the medical care you need and help you follow the doctor’s orders.

Often, the plan will cater to its members through its network of healthcare providers. An SNP specializing in chronic heart failure, for example, may give its members access to a network of providers who specialize in treating chronic heart failure. The plan would also assist in clinical case management and would cover the prescription drugs used to treat chronic heart failure.

Chronic Condition SNPs

The Centers for Medicare and Medicaid Services (CMS) has approved 15 chronic conditions that are eligible for specific SNPs. Five pairs of chronic conditions have also been approved to be grouped for SNP care. Plans can even serve people of a customized group of multiple CMS-approved chronic conditions, as long as each member is verified to have all of the qualifying conditions in the combination.

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Institutional SNPs

I-SNPs are for people who are eligible for Medicare Advantage plans (are 65 or older and enrolled in Part A and Part B) who have for at least 90 days needed the level of services provided in a long term care skilled nursing facility, long term care nursing facility, intermediate care facility for individuals with intellectual disabilities, or an inpatient psychiatric facility. These people may be living in the community and require an institutional level of care (LOC) as assessed by an independent party.

Dual Eligible SNPs

D-SNPs cover people who are eligible for both Medicare and Medicaid. The person can be a beneficiary under any state plan under Medicaid (listed below) unless eligibility is restricted to certain levels by their state.

  • Full Medicaid (only);
  • Qualified Medicare Beneficiary without other Medicaid (QMB Only);
  • QMB Plus;
  • Specified Low-Income Medicare Beneficiary without other Medicaid (SLMB Only);
  • SLMB Plus;
  • Qualifying Individual (QI); and
  • Qualified Disabled and Working Individual (QDWI)

Do you live in Illinois, Missouri, or Iowa and want to know if you qualify for a SNP? Reach out to us today!