What are Medicare Special Needs Plans (SNPs)?

Special Needs Plans (SNPs) are Medicare-approved, managed care plans designed for people with specific health care needs. The people who qualify for these Medicare Advantage (Medicare Part C) plans often need a considerable amount of medical care, so SNPs usually focus on helping members receive well-coordinated care. Special Needs Plans offer the same benefits of Original Medicare—hospital and medical insurance—along with coordinated care for specific medical conditions, such as congestive heart failure (CHF) or diabetes. By providing this specialized care coordination for those with complex health needs, these plans can help recipients stay healthier while lowering overall costs.

Who Qualifies for a Special Needs Plan?

There are three main groups of people who qualify for a SNP.

Medicare beneficiaries who reside in a skilled nursing or assisted living facility because they cannot care for themselves.

For residents of long-term care facilities, SNPs offer specialized attention, which may include visits from nurse practitioners, and care coordinated with physicians and family members.

Dual Eligibles – Medicare beneficiaries who qualify for both Medicare and Medicaid.

Medicaid is a government service that includes programs to help eligible persons pay Medicare premiums and cost sharing. If you qualify for Medicaid, there are Special Needs Plans designed especially for your unique needs and circumstances. Some SNPs serve people who are residents of long-term care facilities AND who are “dual eligibles.”

People with certain chronic medical conditions, such as heart disease or diabetes.

For those with certain chronic medical conditions, Special Needs Plans offer coordinated care management, dedicated specialists and nurse practitioners who create and actively manage the care plan that best meets the beneficiaries’ health care needs. This type of care can hopefully reduce hospitalizations and help beneficiaries to move to a lower risk group on the care continuum.

For example, for a Medicare beneficiary with congestive heart failure (CHF), a Special Needs Plan may include:

  • Access to providers skilled in treating CHF
  • A clinical case management plan that includes education, dietary management and fitness goals
  • A specialized prescription drug formulary designed to treat CHF

SNP Enrollment Periods

If you think a Special Needs Plan may be right for you, there are three main time periods in which you can enroll.

1.  Initial Enrollment Period – If you are newly eligible for Medicare, you may join a SNP at the same time you join Original Medicare, during your Initial Enrollment Period (IEP). Your IEP is the 7-month window that begins three months before your 65th birthday, includes the month of your 65th birthday, and extends three months after your 65th birthday.

2.  Annual Enrollment Period (AEP) – If you already have Medicare, you may join an SNP during the Medicare Annual Enrollment Period: October 15 – December 7 each year.

3.  Special Enrollment Period – If you qualify for an SNP based on a chronic or disabling medical condition, you are eligible to join at any time throughout the year. After joining a plan, however, your enrollment period closes until the following year’s AEP

 

– This information was provided by Medicare Made Clear

 

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