Special Needs Plans (SNPs)
A special kind of coordinated care plan exists called a Special Needs Plan. These are a unique kind of Medicare Advantage plan offered by private insurance companies for certain qualified individuals.
What is a Special Needs Plan?
Special Needs Plans are special kinds of Medicare Advantage plans that have benefits that cover special health care or financial needs. All SNPs include prescription drug coverage, but availability of plans will depend on where you live. There are four kinds of Special Needs Plans.
- Dual Special Needs Plans (D-SNPs) for people who have both Medicare and Medicaid (called “dual eligible”)
- Chronic Special Needs Plans (C-SNPs) for people living with severe or disabling chronic conditions
- Institutional Special Needs Plans (I-SNPs) for people who live in a skilled nursing facility
- Institutional-Equivalent Special Needs Plans (IE-SNPs) for people who live in a contracted assisted living facility and need the same kind of care as those who live in a skilled nursing facility
What do Special Needs Plans Cover?
Special Needs Plans cover the same health care services that all Medicare Advantage plans must including Medicare Part A and Part B. Some SNPs may also cover extra services tailored to the specific group they're designed to serve; however, all Special Needs Plans are required to provide prescription drug coverage. You'll want to review each plan you may qualify for carefully to learn exactly what benefits and services will be covered.
What is a Dual Special Needs Plan (D-SNP)?
Dual Special Needs Plans are for people who have both Medicare and Medicaid (called "dual eligible"). A Dual Special Needs Plan (D-SNP) is a unique Medicare Advantage plan that combines your Medicare Part A and Part B benefits, and your Medicare Part D prescription drug coverage. You'll get extra support to help coordinate the plan with your Medicaid plan. In addition, a dual health plan provides extra benefits not provided by either Medicare or Medicaid.
Who qualifies for a Dual Special Needs Plan?
To qualify for a D-SNP, you must receive Original Medicare (Parts A and B) and full Medicaid benefits. Depending on the amount of Medicaid benefits you receive, you may be considered a "full dual-eligible" or a "partial dual-eligible." If you receive full Medicaid benefits, you will be fully dual-eligible. Most of the time, individuals who qualify get a letter from their state Medicaid office. You can also call to find out your status.
What extra benefits may be included with a Dual Special Needs Plan?
Dental, vision and hearing coverage, care coordination via a personal care coordinator, personal emergency response system (PERS), tele-health options such as virtual medical visits with your doctor, credits to buy health products, plus transportation assistance and more. These are just a handful of examples of the extra benefits Dual Special Needs Plans typically include. Each plan is different, so be sure to look at what's available where you live.
What happens to my Medicaid benefits?
A Dual Special Needs Plan doesn't replace your Medicaid plan or change your Medicaid eligibility. You'll keep the same Medicaid plan you have today, and you'll still get all the same Medicaid benefits you get now.
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What is a Chronic Special Needs Plan (C-SNP)?
Chronic Special Needs Plans (C-SNPs) are for people with a severe or disabling long-term health problem. Some plans are designed only for people with a certain condition, such as for people with diabetes or chronic heart failure.
There are 15 SNP-specific chronic conditions approved by the Centers for Medicare & Medicaid Services (CMS):
- Chronic alcohol and other drug dependences
- Autoimmune disorders limited to: Polyarteritis nodosa, Polymyalgia rheumatica, Polymyositis, Rheumatoid arthritis and Systemic lupus erythematosus
- Cancer (excluding pre-cancer conditions or in-situ status)
- Cardiovascular disorders limited to: Cardiac arrhythmias, Coronary artery disease, peripheral vascular disease and Chronic venous thromboembolic disorder
- Chronic heart failure
- Diabetes mellitus
- End-stage liver disease
- End-stage renal disease (ESRD) requiring dialysis
- Severe hematologic disorders limited to: Aplastic anemia, Hemophilia, Immune thrombocytopenic purpura, Myelodysplastic syndrome and Sickle-cell disease (excluding sickle-cell trait)
- Chronic lung disorders limited to: Asthma, Chronic bronchitis, Emphysema, Pulmonary fibrosis and Pulmonary hypertension
- Chronic and disabling mental health conditions limited to: Bipolar disorders, Major depressive disorders, Paranoid disorder, Schizophrenia and Schizoaffective disorder
- Neurological disorders limited to: Amyotrophic lateral sclerosis (ALS), Epilepsy, Extensive paralysis (hemiplegia, quadriplegia, paraplegia, monoplegia), Huntington’s disease, Multiple sclerosis, Parkinson’s disease, Polyneuropathy, Spinal stenosis and Stroke-related neurologic deficit
The C-SNPs available vary from company to company. You'll need to check directly with a plan provider to see if they offer one that meets your health care needs.
What is an Institutional Special Needs Plan (I-SNP)?
Institutional Special Needs Plans (ISNPs) are for individuals who live in a care facility like a nursing home or get nursing care at home. These plans are for people who have had, or are expected to need, for 90 days or longer, the level of services provided in one of the following:
- A long-term care skilled nursing facility
- A long-term care nursing facility
- A skilled nursing facility/nursing facility
- An intermediate care facility for individuals with intellectual disabilities
- An inpatient psychiatric facility
What is an Institutional-Equivalent Special Needs Plan (IE-SNP)?
Institutional-Equivalent Special Needs Plans (IE-SNPs) are for people who live in an assisted living facility and get the same kind of care as in a skilled nursing facility.
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