Paul Sanchez
Special Needs Plans (SNP) are a type of Medicare Advantage plan that offers benefits and services to people with specific conditions, certain healthcare needs, or those with Medicaid. SNPs are designed to provide targeted care and limit enrollment to special needs individuals, such as those with severe or disabling chronic conditions, dual eligibles, or institutionalized individuals. There are three main types of SNPs: Dual Special Needs Plans (D-SNPs), Chronic Special Needs Plans (C-SNPs), and Institutional Special Needs Plans (I-SNPs). Each SNP provides prescription drug coverage and additional benefits like dental, vision, and hearing coverage, care coordination, and transportation assistance. SNPs are offered by private insurance companies and are subject to existing MA program rules and regulations.
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What You'll Learn
SNP definition and history
A Special Needs Plan (SNP) is a type of Medicare Advantage plan that combines all the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D). SNPs are only available to people with an additional qualifying condition or those eligible for both Medicare and Medicaid. SNPs are private companies that the federal government pays to administer Medicare benefits.
SNPs were first offered in 2006. The Medicare, Medicaid, and State Children’s Health Insurance Program (SCHIP) Extension Act of 2007 extended the SNP program from December 31, 2008, to December 31, 2009, but imposed a moratorium that prohibited CMS from approving new SNPs after January 1, 2008. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) lifted the moratorium on approving new SNPs. Effective immediately upon its enactment in 2011, section 3205 of the Patient Protection and Affordable Care Act (“ACA”) extended the SNP program through December 31, 2013. The program was further extended through December 31, 2018, by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
There are three types of SNPs: Chronic Condition SNPs (C-SNPs), Dual-Eligible Special Needs Plans (D-SNPs), and Institutional Special Needs Plans (I-SNPs). C-SNPs offer special care for people with diabetes, cardiovascular disorders, chronic heart failure, chronic lung disorders, cancer, dementia, HIV/AIDS, stroke, End-Stage Renal Disease (ESRD), and other qualifying conditions. D-SNPs are for people who have both Medicare and Medicaid. With a D-SNP, all Medicare and Medicaid benefits are combined into one easy-to-manage plan. I-SNPs are for people who live in a skilled nursing facility. A person who lives in a contracted assisted living facility and needs the same kind of care as those who live in a skilled nursing facility may qualify for an Institutional-Equivalent Special Needs plan (IE-SNP). This is still considered an I-SNP.
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SNP eligibility
Special Needs Plans (SNPs) are a type of Medicare Advantage plan that offers benefits and services to individuals with specific conditions, certain healthcare needs, or those with Medicaid. SNPs are designed to provide targeted care and limit enrollment to those who meet the criteria.
There are three main types of SNPs:
- Dual Special Needs Plans (D-SNPs): These plans are for individuals who are eligible for both Medicare and Medicaid, often referred to as "dual eligibles." D-SNPs combine the benefits of Medicare Part A, Part B, and Part D prescription drug coverage with those of Medicaid, providing a single, comprehensive plan.
- Chronic Special Needs Plans (C-SNPs): C-SNPs are designed for individuals living with severe or disabling chronic conditions. These plans offer specialized care for people with diabetes, cardiovascular disorders, chronic heart failure, chronic lung disorders, or other CMS-approved qualifying conditions.
- Institutional Special Needs Plans (I-SNPs): I-SNPs are meant for individuals residing in skilled nursing facilities or contracted assisted living facilities who require a similar level of care.
Eligibility for SNPs is determined by specific criteria, including an individual's health status, Medicare and Medicaid eligibility, and the availability of plans in their geographic location. It is important to note that SNPs are not available in all areas, and the specific benefits offered may vary depending on the plan and the individual's circumstances.
To enroll in a SNP, individuals can refer to the Medicare Managed Care Manual for guidance and check with private insurance companies offering these plans in their area. SNPs aim to provide tailored benefits and services to meet the unique needs of those who qualify.
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Types of SNP: Dual Special Needs Plans (D-SNPs)
Special Needs Plans (SNPs) are a type of Medicare Advantage plan offered by private insurance companies for certain qualified individuals. SNPs are designed to provide targeted care and limit enrollment to special needs individuals. Dual Special Needs Plans (D-SNPs) are a type of SNP designed for people who are dually eligible for both Medicare and Medicaid. To qualify for a D-SNP, an individual must receive Original Medicare (Parts A and B) and full Medicaid benefits.
D-SNPs combine an individual's Medicare Part A and Part B benefits with their Medicare Part D prescription drug coverage. They also provide extra support to help coordinate the plan with the individual's Medicaid plan. In addition, D-SNPs offer extra benefits not provided by either Medicare or Medicaid, such as dental, vision, and hearing coverage, care coordination via a personal care coordinator, personal emergency response systems (PERS), telehealth options, credits to buy health products, transportation assistance, and more.
D-SNPs are required to contract with states, but states are not required to contract with D-SNPs. As of February 2022, D-SNPs were operating in 45 states and the District of Columbia, with about 3.8 million dually eligible beneficiaries enrolled. However, there are differences in D-SNP enrollment across states, which may be due to factors such as state-level policies, demographic characteristics of the dual-eligible population, firm strategy, and the ability to establish care networks for dual-eligible individuals.
There are also different levels of integration for D-SNPs, including Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs) and Highly Integrated Dual Eligible Special Needs Plans (HIDE SNPs). FIDE SNPs fully integrate care for dually eligible beneficiaries under a single managed care organization, while HIDE SNPs have an even higher level of integration and must include coverage of long-term services and supports, behavioral health, or both.
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Types of SNP: Chronic Special Needs Plans (C-SNPs)
Special Needs Plans (SNPs) are a type of Medicare Advantage plan offered by private insurance companies for certain qualified individuals. SNPs provide benefits and services to people with specific severe and chronic diseases, certain health care needs, or who also have Medicaid. Chronic Special Needs Plans (C-SNPs) are a type of SNP designed for people living with severe or disabling long-term health problems, including chronic conditions.
C-SNPs are tailored to individuals with specific severe or disabling chronic conditions, as defined by the Centers for Medicare and Medicaid Services (CMS). CMS has identified a list of SNP-specific chronic conditions, which include but are not limited to autoimmune disorders, cancer, cardiovascular disorders, severe hematologic disorders, chronic heart failure, and diabetes mellitus. C-SNPs are permitted to target a group of commonly co-morbid and clinically linked chronic conditions. For example, a C-SNP may focus on enrollees with diabetes mellitus and chronic heart failure, or diabetes mellitus, chronic heart failure, and cardiovascular disorders.
To enrol in a C-SNP, individuals need to have at least one of the qualifying conditions. MAOs (Medicare Advantage Organizations) that offer C-SNPs must verify that enrollees meet the eligibility criteria. C-SNPs provide specialized care and benefits tailored to the specific group they serve. This may include extra services such as extended hospital stays for individuals with severe conditions.
The availability of C-SNPs can vary from company to company, and individuals should review the plans offered by different providers to find one that meets their specific healthcare needs. It is important to carefully consider the benefits and services covered by each plan to ensure they align with an individual's unique healthcare requirements.
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Types of SNP: Institutional Special Needs Plans (I-SNPs)
Special Needs Plans (SNPs) are a unique kind of Medicare Advantage plan offered by private insurance companies for certain qualified individuals. They are designed to provide targeted care and limit enrollment to special needs individuals. Institutional Special Needs Plans (I-SNPs) are a type of SNP that restricts enrollment to individuals who have had or are expected to need the services provided in a long-term care (LTC) skilled nursing facility for 90 days or longer. This includes individuals living in contracted assisted living facilities who require the same level of care as those in a skilled nursing facility, which is known as an Institutional-Equivalent Special Needs plan (IE-SNP).
I-SNPs are available to individuals who meet the criteria for requiring an institutional level of care (LOC) as determined by a state assessment tool. This assessment must be administered by an independent, impartial party with the professional knowledge to accurately identify the institutional LOC needs. Additionally, I-SNPs must follow existing MA program rules and regulations, including Medicare-covered services and Prescription Drug Benefit program rules.
If an I-SNP enrollee changes residence, the plan must document its preparedness to implement a CMS-approved MOC at the new residence or another I-SNP contracted LTC setting that provides an equivalent level of care. The availability of I-SNPs may vary based on location, and interested individuals should review the specific plans available in their area to understand the benefits and services offered.
Overall, Institutional Special Needs Plans (I-SNPs) are an important component of SNPs, ensuring that individuals requiring long-term care in skilled nursing facilities or equivalent settings have access to the necessary services and benefits to meet their unique healthcare needs.
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Frequently asked questions
SNP stands for Special Needs Plans. These are a unique kind of Medicare Advantage plan offered by private insurance companies for certain qualified individuals.
SNP insurance is for special needs individuals, which may include:
- People with a severe or disabling chronic condition.
- People who are institutionalized.
- People who are dual eligibles (those who have both Medicare and Medicaid).
SNP insurance provides benefits and services to people with specific conditions, certain health care needs, or who also have Medicaid. All SNPs include prescription drug coverage, but the availability of plans will depend on where you live. Other benefits may include dental, vision and hearing coverage, care coordination, personal emergency response systems, and transportation assistance.
