Special Needs Plans
Special Needs Plans (SNPs) are considered a type of Medicare Advantage plan, providing affordable coverage and tailored benefits to those with qualifying financial or medical needs.
Medicare Advantage and SNPs
As a type of Medicare Advantage (Part C) plan, SNPs are required to cover the same benefits as Original Medicare, which include short-term hospital and nursing home care, as well as general medical treatments and preventative services.
Unlike other Advantage plans, SNPs are also required to include Medicare drug coverage (Part D).
You can join an SNP at any time. So, if you qualify for one after your initial Medicare enrollment, you can switch over to an SNP.
How They Work
SNPs can function in a number of different ways. However, you’ll often find that they are similar to Health Maintenance Organization (HMO) plans, but with added benefits to treat your qualifying condition or financial situation.
SNPs function within a network of healthcare providers. Unlike HMOs, some plans offer minimal out-of-network coverage, but not all do. But, like HMOs, you will be asked to choose a primary care provider or coordinator and obtain a referral from them before you receive specialist care.
The Types of SNPs
There are three types of Special Needs Plans (SNPs) you can qualify for:
- Chronic Condition SNP (C-SNP): C-SNPs are limited to those with a qualifying chronic condition. You will receive benefits tailored to your specific condition to ensure you receive coverage for the treatments you need. Qualifiers include:
- Autoimmune disorders
- Cancer (excluding pre-cancer conditions)
- Cardiovascular disorders
- Chronic heart failure
- Chronic lung disorders
- Chronic and disabling mental health conditions
- Dementia
- Diabetes mellitus
- End-stage liver disease
- End-Stage Renal Disease (ESRD) requiring dialysis
- HIV/AIDS
- Neurologic disorders
- Severe hematologic disorders
- Stroke
- Institutional SNP (I-SNP): You live in an institution such as a nursing home or require nursing care at home.
- Dual Eligible SNP (D-SNP): You must have both Medicare and Medicaid to qualify for a D-SNP. There are different types of D-SNPs based on the level of financial assistance you need, but as long as you have both Medicare and Medicaid you can receive D-SNP coverage.
Understand Your Coverage Needs
Navigating enrollment for an SNP is better when you have help from someone you can trust. Call or email Priority Health Insurance Services today.
