Special Needs Plans (SNPs)

What are Special Needs Plans (SNPs)

Special Needs Plans (SNPs) are Medicare Advantage (Part C) plans tailored for people with specific circumstances or health needs. They provide all Part A and Part B benefits and usually include Part D drug coverage, plus a coordinated Model of Care (care team, individualized care plans, and targeted benefits). There are three types: C-SNPs for certain chronic conditions (e.g., diabetes, heart failure, COPD, CKD, HIV/AIDS), D-SNPs for people who have both Medicare and Medicaid (dual eligible), and I-SNPs for those living in or needing nursing-home–level care (including qualifying home-based care). SNPs typically feature condition-focused networks, extra benefits (like transportation, dental/vision/hearing, OTC), and lower, more predictable costs. Enrollment is available at standard Medicare periods, and many people qualify for a Special Enrollment Period when they newly meet SNP eligibility.

Chronic Condition Special Needs Plans
(C-SNPs)

What is Chronic Condition Special Needs Plan (C-SNP)

A C-SNP is a type of Medicare Advantage (Part C) plan that’s customized for people with specific chronic or severe medical conditions.
It offers coordinated care, specialized provider networks, and condition-focused benefits to help manage ongoing health needs more effectively than standard MA plans.

Benefits of Chronic Condition Special Needs Plan (C-SNP)

Tailored Care Coordination: Each member receives an individualized care plan with a care team that includes doctors, specialists, and care managers.
Integrated Drug Coverage: Most C-SNPs include Part D prescription drug coverage, focusing on medications for the qualifying condition.
Condition-Focused Networks: Access to specialists experienced in treating your specific illness.
Extra Benefits: May include transportation to medical appointments, nutrition counseling, fitness, or telehealth.
Predictable Costs: Low copays and maximum out-of-pocket protection for covered services.

Eligibility for Chronic Condition Special Needs Plan (C-SNP)

You can join a C-SNP if you:

Are enrolled in Medicare Parts A and Part B, and
Live in the plan’s service area, and
Have a diagnoses with chronic or disabling condition approved by CMS (such as):

Diabetes.
Chronic heart failure or cardiovascular disorders.
COPD or other lung conditions.
Chronic kidney disease (including ESRD).
HIV/AIDS.
Certain neurological or disabling mental health conditions.

Enrollment in Chronic Condition Special Needs Plan (C-SNP)

You can enroll:

When first eligible for Medicare (Initial Enrollment Period).
During the Annual Enrollment Period (AEP) — Oct 15 – Dec 7.
During a Special Enrollment Period (SEP) — anytime you are diagnosed or newly qualify for the chronic condition that matches a C-SNP.

Dual Eligible Special Needs Plans
(D-SNPs)

What is Dual Eligible Special Needs Plan (D-SNP)

A D-SNP is a Medicare Advantage (Part C) plan designed for people who qualify for both Medicare and Medicaid (known as dual eligible).
It combines Medicare coverage (Parts A, B, and usually D) with Medicaid assistance to provide coordinated care and lower costs for people with limited income and resources.

Benefits of Dual Eligible Specials Needs Plan (D-SNP)

You can join a C-SNP if you:

$0 or very low plan premiums – Most D-SNPs have no additional cost beyond what Medicaid covers.
Lower out-of-pocket costs – Medicaid helps pay Medicare premiums, copays, and deductibles.
Prescription drug coverage included (MAPD) – $0 or low-cost copays for medications.
Coordinated care – Case managers and care teams help coordinate between Medicare and Medicaid providers.
Extra benefits beyond Original Medicare, such as:

Dental, vision, and hearing.
Over-the-counter (OTC) allowances.
Transportation to appointments.
Healthy food or grocery cards.
Fitness, wellness, and telehealth services.

Eligibility for Dual Eligible Special Needs Plan (D-SNP)

To qualify for a D-SNP, you must:

Are enrolled in Medicare Parts A and Part B, and
Live within the plan’s service area.
Be enrolled in Medicaid (full or partial):

Full Dual Eligible (QMB+, SLMB+, or full Medicaid): Medicare and Medicaid share coverage and costs.
Partial Dual Eligible (QMB, SLMB, QI): Medicaid helps pay Part B premiums but may offer fewer extra benefits.

Enrollment in Dual Eligible Special Needs Plan (D-SNP)

You can enroll in a D-SNP:

When you first qualify for both Medicare and Medicaid.
At any time during the year — you’re not limited to the standard enrollment periods.
Through Special Enrollment Periods (SEPs) if your Medicaid status changes (gain, lose, or switch levels of eligibility).

Institutional Special Needs Plans
(I-SNPs)

What is Institutional Special Needs Plan (I-SNP)

An I-SNP is a type of Medicare Advantage (Part C) plan created for individuals who live in an institution (like a nursing home or skilled nursing facility) or who need institutional-level care at home.
These plans are tailored to provide personalized, coordinated care for people with complex or long-term health needs.

Benefits of Institutional Special Needs Plan (I-SNP)

Comprehensive coordinated care:
Members receive an individualized care plan managed by a dedicated care team (nurses, care coordinators, and primary care providers).
Integrated prescription drug coverage (MAPD):
Most I-SNPs include Part D coverage for medications.
On-site or in-home medical care:
Frequent visits from healthcare professionals within the facility or home setting.
Chronic care management:
Focused on managing ongoing conditions such as dementia, heart disease, or mobility limitations.
Extra benefits:
May include dental, vision, hearing, transportation, telehealth, and wellness programs designed for residents in care settings.
Low out-of-pocket costs:
Predictable cost-sharing and no network restrictions within the facility or care provider system.

Eligibility for Institutional Special Needs Plan (I-SNP)

To qualify for an I-SNP, you must:

- Be enrolled in Medicare Parts A and Part B, and
- Live in or require long-term care in one of the following:

-- Nursing home or skilled nursing facility.
-- Intermediate care facility.
-- Assisted living or long-term care facility.
-- Or, receive home and community-based services (HCBS) requiring institutional-level care.
- Live within the plan’s service area.

The plan must verify that the member meets institutional or nursing home level-of-care requirements.

Eligibility for Institutional Special Needs Plan (I-SNP)

You can enroll in an I-SNP:

When you first become eligible for Medicare.
At any time during the year if you move into or reside in an eligible facility.
Through a Special Enrollment Period (SEP) when your care status changes (e.g., entering or leaving a facility).

Chronic Condition Special Needs Plan (C-SNP)

Dual Eligible Special Needs Plan (D-SNP)

Institutional Special Special Needs Plan (I-SNP)

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