Special Needs Plans (SNPs)

Special Needs Plans (SNPs) coordinate benefits between Medicare and Medicaid to provide benefits, formularies, and services tailored to individuals with special needs. SNPs are Medicare Advantage plans with HMO, PPO, and HMO-POS structures. Insurance companies do not offer these plans everywhere and benefits vary, although common benefits are typically assignment of care coordinators and ability to utilize Special Enrollment Periods quarterly. There are three primary categories of SNPs:

1. Dual Eligible SNP (D-SNP)
2. Chronic Condition SNP (C-SNP)
3. Institutional SNP (I-SNP)

D-SNPs are for individuals who have both Medicare and Medicaid. The Medicaid eligibility categories vary by state, but typically include different levels. As the special need for those on Medicaid is financial hardship, the benefits limit or exclude costs for care.

C-SNPs are for individuals who need additional help due to a chronic or disabling condition or illness. Although The Center for Medicare and Medicaid Services defines chronic conditions allowable for such plans, individual insurance companies can choose which of those chronic conditions they choose to offer and where they will offer them.

I-SNPs are for individuals who reside or are expected to reside for 90 days or longer in a long-term care facility, or those living in the community but requiring a level of care equivalent to those residing in a long-term care facility.