What Are Special Needs Plans?

Medicare Special Needs Plans, or SNPs, are one of the types of Medicare Advantage Plans, also known as Medicare Part C. This private insurance plan is designed for those with specific diseases or chronic health conditions. With this plan, benefits can be customized to meet your healthcare needs. SNPs include prescription drug coverage, also called Medicare Part D.

SNP eligibility limited to people with certain diseases or chronic health conditions is called Chronic Condition SNP, or C-SNP. Some of these health conditions include autoimmune disease, chronic heart failure, dementia, HIV/AIDS, End-Stage Renal Disease (ESRD), etc. 

SNPs are also available to individuals who reside in an institution, like nursing homes. This is called Institutional SNP or I-SNP. 

Those who are enrolled in both Medicare and Medicaid may also be eligible for SNPs. This is called Dual Eligible SNP or D-SNP.

Like all other Medicare Advantage Plans, you also must be enrolled in Medicare Parts A and B to be eligible.

How SNPs Work

Those with SNPs are limited to hospitals, doctors, and other healthcare providers within their plan’s network. You must choose a primary care doctor, and you will need referrals for most specialists under this plan. 

The only exception to getting out-of-network services is in the case of getting emergency care or if you have ESRD and require out-of-area dialysis. 

SNP Cost

Having an SNP means paying a monthly premium for that plan. Costs vary depending on whether your plan includes added benefits.  

Benefits of SNPs

One major benefit of this plan is that it can be customized to meet your specific healthcare needs. Another benefit of SNPs is that they must cover prescription drugs, or Medicare Part D, which is not the case for all Medicare Advantage Plans. 

Cons of SNPs

SNPs have very specific requirements for eligibility. Suppose your health status or situation changes, making you ineligible for the plan. In that case, you will have to enroll in a different plan. SNPs are not offered everywhere, so it is also important to find out if this type of plan is available in your area. Another consideration to make is that SNPs require referrals for most specialized care. 

Learn More About SNPs

Interested in learning more about SNPs? Thomas Family Insurance is here to help. Call us today to discuss your options at 217-740-4166.