What Is a Medicare SNP and How Does It Work?
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Medicare SNPs, or Special Needs Plans, are Medicare Advantage plans that provide coverage for certain specialized groups of people.
You may be eligible for an SNP if you live with a chronic or debilitating health condition, need long-term inpatient care or are eligible for both Medicare and Medicaid.
What is a Medicare SNP?
A Medicare Special Needs Plan is a type of Medicare Advantage plan built for those with certain specific health care needs.
Also called Medicare Part C plans, Advantage plans bundle multiple types of Medicare coverage together. SNPs, like other Advantage plans, are sold by private insurance companies. This means that the availability and benefits of SNPs could vary based on where you live.
A Medicare SNP offers targeted care options for certain groups. For example, you're only able to join an SNP tailored to the needs of those with end-stage liver disease if you have that condition. The SNP offers a network of health care providers who specialize in the needs of those with end-stage liver disease. The plan's coverage drug list might also be limited to drugs used to treat liver disease. SNPs may also offer staffers who help patients navigate their care called care coordinators.
Who qualifies for Medicare Special Needs Plans?
To qualify for SNP insurance you must need specialized medical care or be eligible for both Medicare and Medicaid.
Medicare offers three types of SNPs, each with specific qualifications.
- C-SNPs are for groups of people with specialized health needs, like those with cancer, dementia or certain lung disorders.
- D-SNPs are for people who are eligible for both Medicare and Medicaid and can help coordinate care benefits. This is the most common type of SNP.
- I-SNPs are for those who are living in or who expect to live in a care facility such as a rehabilitation hospital or nursing home for 90 or more continuous days or those who live outside a facility but need the same level of care.
Not everyone who is eligible for Medicare will be eligible for an SNP. But if you do qualify for a Special Needs Plan, you may find that the benefits better fit your unique needs.
C-SNPs
To qualify for a Chronic Condition SNP, also called a C-SNP, you must have one or more of the following severe, chronic or disabling conditions:
- Autoimmune disorders
- Blood disorders
- Cancer (excluding precancerous conditions)
- Cardiovascular disorders
- Dementia
- Dependence (alcohol or other)
- Diabetes mellitus
- End-stage liver disease
- End-stage renal disease (ESRD) that requires dialysis
- Heart failure
- HIV/AIDS
- Lung disorders
- Mental health conditions
- Neurological disorders
- Stroke
Not all conditions qualify, even within the list. For example, only some autoimmune conditions have C-SNPs built around them.
D-SNPs
Dual-Eligible SNPs, also called D-SNPs, are for those who qualify for both Medicare and Medicaid. The SNP can help coordinate benefits across the two coverage types.
Federal law requires that certain groups, including low-income families, qualifying children, qualifying pregnant women and individuals with disabilities, are eligible. Medicaid benefits are administered on a state level, and some states choose to offer benefits to other groups.
If you qualify for a D-SNP, you may also pay less for health care since these plans are designed to help you navigate your coverage. Medicaid programs vary by state, and having a D-SNP care coordinator can help you make the most of your benefits. For example, Medicare should always pay first for covered services, and Medicaid will pay for any remaining covered costs. Usually, this results in relatively low out-of-pocket costs.
I-SNPs
An Institutional Special Needs Plan, or I-SNP, requires that you are in or expected to be in a care facility, such as the ones listed below, for 90 or more consecutive days.
- Intermediate care facility
- Long-term care hospital
- Nursing home
- Psychiatric hospital
- Rehabilitation hospital
- Skilled nursing facility
- Swing-bed hospital
Other facilities may qualify. If you don't live in a care facility but still have the same needs as those who do, you may qualify for an I-SNP. For example, if you're recovering from a surgery in your own home but need the same level of care that a rehabilitation hospital would provide, you might qualify for an I-SNP.
What do SNPs cover?
SNPs cover everything that other Medicare Advantage plans cover and may have specific additional benefits.
Medicare Advantage plans bundle together coverage for Medicare Part A (hospital coverage) and Medicare Part B (outpatient care coverage). While not all Medicare Advantage plans include Medicare Part D (prescription drug coverage), all of the three types of Special Needs Plans are required to include it.
Because SNPs are designed to serve patients with particular needs, they may also include additional coverage perks, like higher limits for hospital stays. Many SNPs also include dental and vision coverage.
How much do SNPs cost?
The average cost of an SNP is $31 per month, but costs vary depending on the type of SNP you purchase.
For most people, Medicare Part A costs $0 per month, while Medicare Part B costs a standard amount of $164.90 per month, although if you earn more, you will pay more. SNPs include Part D, so you won't pay anything extra for drug coverage.
Average SNP costs also vary by the health insurance company that sells the coverage.
Company | Average monthly cost |
|---|---|
| Cigna | $23 |
| Wellcare | $27 |
| Anthem | $28 |
| UnitedHealth Group | $31 |
| Humana | $33 |
These are average SNP rates by company, but remember that costs will also vary based on the type of SNP you join.
Benefits and drawbacks of SNPs
Medicare SNPs have pros and cons, such as the advantage of specialized benefits or the downside of a limited provider network. Many of those are similar to the advantages and disadvantages of Medicare Advantage plans.
Perks
Offers specialized benefits based on your health needs.
Provides health care professionals called care coordinators who can help you navigate your benefits.
Costs are generally fairly low.
Drawbacks
Sold by private health insurance companies, which means plans may vary by region.
Provider networks may be more limited.
May need a referral if you want to see a specialist.
How to join an SNP
If you're already covered by Medicare, you can join an SNP at any time. Developing a condition, needing institutionalized care, or qualifying for both Medicare and Medicaid usually allows you to enroll at any time because these are considered special enrollment situations.
You can view various SNPs in your area on Medicare.gov. Depending on the plan, you might be able to enroll there or you may need to contact the health insurance company that sells the plan.
To join an SNP, you'll first need to be eligible for Medicare. Medicare Parts A and B have three enrollment periods, or periods of time when you can sign up for coverage.
- Initial enrollment: This is the most common time to enroll in Medicare and generally happens when you turn 65, although you may qualify for Medicare earlier if you have a disability, kidney failure (ESRD) or amyotrophic lateral sclerosis (ALS). For those qualifying due to age, your initial enrollment period begins three months before the month you turn 65 and ends three months later, so you have a total of seven months to enroll.
- General enrollment: If you don't sign up during your initial enrollment period, you can sign up between Jan. 1 and March 31 of every year, but you may pay a penalty unless you qualify for special enrollment.
- Special enrollment: In some circumstances, you can sign up for Medicare Parts A and B outside of the initial and general enrollment periods without paying a late penalty. These include missing your chance to sign up due to a natural disaster, incorrect information from a health plan or employer, or volunteering or serving in another country.
As you're looking for coverage, remember that SNPs are sold by insurance companies and don't come directly from the government. You can compare plans on Medicare.gov or reach out to a company directly.
Frequently asked questions
Do SNPs have provider networks?
Yes, SNPs have provider networks. Your SNP will function as either an HMO (health maintenance organization), PPO (preferred provider organization) or HMO-POS (HMO point-of-service) insurance network. Each SNP will likely have a different network of providers appropriate for the needs of the patients in that particular SNP group.
What does an SNP care coordinator do?
A care coordinator helps the patients of specific SNPs navigate their health care. A C-SNP for people with chronic heart disease might have a care coordinator to help patients understand their prescriptions, make lifestyle changes to manage their condition and understand their surgical options.
How long can I stay in an SNP?
You can stay in an SNP as long as you meet the qualifications. For example, you may be part of an I-SNP because you are living in a long-term care facility. If you are discharged and allowed to return to your home without needing the same level of care, you'll no longer qualify for I-SNP coverage. You'll be disenrolled and can rejoin if you qualify again during the plan's grace period or if you meet the requirements for the special enrollment period.
Methodology
Medicare SNP costs are calculated from public use files (PUFs) on the Centers for Medicare & Medicaid Services (CMS) government website. Rates are based on 2023 Medicare Advantage Special Needs Plans and include drug coverage. Employer-sponsored plans, sanctioned plans and state-specific Medicare-Medicaid Plans (MMPs) were excluded from our analysis.
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