Medicare Advantage Special Needs Plans

What is a Medicare Special Needs Plan (SNP)?

A Medicare Special Needs Plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) that limits enrollment to individuals with certain special needs, and provides benefits, provider choices, and drug formularies (list of covered drugs) to best meet the specific needs of the groups they serve. All Special Needs Plans include prescription drug coverage.

Who Can Join a Medicare SNP?

You can join a Medicare SNP if you have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), live in the plan’s service area, and meet the plan’s eligibility requirements.

There are 3 main populations who may benefit by enrolling in a SNP:

  • Individuals with a severe or disabling chronic condition, as specified by CMS may enroll in a Chronic Condition Special Needs Plan (C-SNP).
  • Individuals eligible for both Medicare and Medicaid (Dual Eligible) may enroll in a Dual Eligible Special Needs Plan(D-SNP).
  • Individuals who are institutionalized may enroll in a Dual Eligible Special Needs Plan(D-SNP).

What Are the Types of SNPs, and What Do They Offer?

CHRONIC CONDITION SPECIAL NEEDS PLANS (C-SNPs)

Chronic Condition Special Needs Plans are designed to provide coverage for people with a select chronic condition or for people who may suffer from one (or more) of many chronic conditions. These include:

■ Chronic alcohol and other drug dependence ■ Autoimmune disorders ■ Cancer (excluding pre-cancer conditions) ■ Cardiovascular disorders ■ Chronic heart failure ■ Dementia ■ Diabetes mellitus ■ End-stage liver disease ■ End-Stage Renal Disease (ESRD) requiring any mode of dialysis ■ Severe hematologic disorders ■ HIV/AIDS ■ Chronic lung disorders ■ Chronic and disabling mental health conditions ■ Neurologic disorders ■ Stroke

C-SNPs are designed to help their members manage their chronic conditions, avoid hospitalizations, and improve their health outlook. Often, they customize their benefits, networks, and drug formularies to better meet the needs of their members.

DUAL ELIGIBLE SPECIAL NEEDS PLANS (D-SNPs)

Dual Eligible Special Needs Plans are a type of MA Special Needs Plan available to individuals eligible for both Medicare and Medicaid. Most

D-SNPs are health maintenance organization (HMO) plans, although some are preferred provider organization (PPO) plans. Each state determines whichD-SNPs a carrier can offer and the benefits they can include.

Generally speaking, D-SNPs include the following:

• Care coordination

• $0 monthly premiums

• Over-the-counter quarterly benefits

• DVH benefits

• Transportation benefits

• Gym memberships

• Telehealth services

There are five types of D-SNPs: All-Dual, Full-Benefit, Medicare Zero Cost

Sharing, Dual Eligible Subset, and Dual Eligible Subset Medicare Zero Cost

Sharing. The type of plan a dual-eligible can enroll in depends upon the

Medicaid category they fall under.

INSTITUTIONAL SPECIAL NEEDS PLANS (I-SNPs)

(I-SNPs) are a type of MA plan that restricts enrollment to individuals who have or will likely need the level of care provided in a long-term care (LTC) skilled nursing facility (SNF), a LTC nursing facility (NF), a SNF/NF, an intermediate care facility for individuals with intellectual disabilities (ICF/IDD), or an inpatient psychiatric facility for 90 days or longer.

I-SNPs are generally not sold by independent agents. Carriers with these plans usually require prospects to enroll directly with the carrier.

MORE INFORMATION

More detailed information may be obtained by contacting CMS. Additionally, there is an excellent booklet produced by the Kaiser Family Foundation, that’s available for download, at:

https://www.kff.org/wp-content/uploads/sites/2/2011/10/11302.pdf