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Medicare Advantage SNPs (Special Needs Plans)

SNPs (Special Needs Plans) are tailored to individuals who suffer from specific diseases or disabilities, have unique health care needs, or are on both Medicare and Medicaid.  There are three types of SNP plans. Each one is organized with a different population in mind, and these plans provide a network of physicians designed to fit beneficiaries’ necessities.

Who can you get treatment from?

What your SNP covers depends on your policy. While some SNPs cover treatment from out-of-network providers, other plans have coverage benefits that only include physicians within the plan’s network. It is important to become familiar with each plan’s policy before enrolling in one.

Do you get prescription drug coverage?

All SNPs must provide prescription drug coverage, so you won’t have to worry about signing up for a separate Medicare drug plan if you enroll in a SNP.

Do you need a referral to see a specialist?

In most cases, SNPs require you to get a referral to see a specialist. Additionally, you typically need to choose a primary care physician, or alternatively a care coordinator, to manage your health care plan.

Types of Medicare Advantage Special Needs Plans

There are three types of SNPs that you can be eligible for, and each one is tailored to a specific population.

Institutional SNP (I-SNP)

I-SNPs are for beneficiaries who reside in care institutions, like nursing homes, or require at-home nursing or health care. To qualify for an I-SNP, you must demonstrate proof of the need for institutionalized care for at least 90 days, even if this entails at-home care.

Dual Eligible SNP (D-SNP)

D-SNPs are for individuals who are eligible for both Medicare and Medicaid. These plans work together with your state Medicaid program to coordinate your Medicare and Medicaid benefits.

Chronic Condition SNP (C-SNP)

People with chronic diseases or disabilities are eligible for C-SNPs. Some examples are people who suffer from cancer, HIV/AIDS, chronic heart conditions, diabetes, epilepsy, and End-Stage Renal Disease.

In the case of individuals suffering from ESRD, new Medicare laws now permit these beneficiaries to enroll in a Medicare Advantage plan (as of January 2021). 

If you think you may be eligible for a Medicare Special Needs Plan, or simply would like to have your Medicare Advantage questions answered, reach out to a licensed insurance agent here at Medicare Plans Direct today.

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