Ed Taylor, Medicare Insurance Agent

Can you explain Special Needs Plans in Medicare?

Answer: This is from the Medicare.gov website:

What's an SNP?

A Special Needs Plan (SNP) provides benefits and services to people with specific severe and chronic diseases, certain health care needs, or who also have Medicaid. SNPs include care coordination services and tailor their benefits, provider choices, and list of covered drugs (formularies) to best meet the specific needs of the groups they serve.

SNPs are either HMO or PPO plan types and cover the same Medicare Part A and Part B benefits that all Medicare Advantage Plans cover. However, SNPs might also cover extra services for the special groups they serve. For example, if you have a severe condition, like cancer or congestive heart failure, and you need a hospital stay, an SNP may cover extra days in the hospital. You can only stay enrolled in an SNP if you continue to meet the special conditions of the plan.

What are the eligibility requirements for SNPs?

Dual Eligible SNP (D-SNP) – You’re eligible for both Medicare and Medicaid. Some D-SNPs may provide Medicaid services in addition to Medicare services. D-SNPs contract with your state Medicaid program to help coordinate your Medicare and Medicaid benefits, depending on the state and your eligibility.

Chronic Condition SNP (C-SNP) – You have one or more of these severe or disabling chronic conditions:

Chronic alcohol and other dependence

Certain autoimmune disorders

Cancer (excluding pre-cancer conditions)

Certain cardiovascular disorders

Chronic heart failure

Dementia

Diabetes mellitus

End-stage liver disease

End-Stage Renal Disease (ESRD) requiring dialysis (any mode of dialysis)

Certain severe hematologic disorders

HIV/AIDS

Certain chronic lung disorders

Certain chronic and disabling mental health conditions

Certain neurologic disorders

Stroke

Institutional SNP (I-SNP) – You live in the community but need the level of care a facility offers, or you live (or are expected to live) for at least 90 days straight in a facility like a:

Nursing home

Intermediate