Medicare Advantage SNPs are a type of Medicare Advantage plan designed to cater to individuals with specific health conditions, health care needs, and financial circumstances. There are three main groups that SNPs are tailored to help:
- Chronic Special Needs: People with chronic health conditions can qualify for a Chronic Special Needs Plan (C-SNP). There are 15 chronic conditions approved by the Centers for Medicare & Medicaid Services (CMS), including Diabetes, COPD, End Stage Renal Disease, and many other conditions. Read more about CSNP plans in our blog, Understanding Medicare Advantage C-SNP Plans.
- Institutional Special Needs: These plans are for individuals who reside in certain institutions, such as long-term care facilities, skilled nursing facilities, rehabilitation hospitals, or an inpatient psychiatric facility. The beneficiary must live (or is expected to live) in the facility for at least 90 straight days to qualify for a Institutional Special Needs Plan (I-SNP).
- Dual Eligible Special Needs: Individuals with low income who are eligible for both Medicare and Medicaid can qualify for a Dual Special Needs Plan (D-SNP). See who qualifies for DSNP in our previous blog, The In’s and Out’s of the Medicare Savings Programs.
How Medicare Advantage SNPs Work
Medicare Advantage SNPs function much like traditional Medicare Advantage plans and must cover at least what Medicare covers. But they typically tailor their benefits to meet the needs of the above groups they serve.
These plans typically offer:
- Specialized Provider Networks: Medicare Advantage SNPs often have networks of healthcare providers who specialize in treating the targeted conditions or providing services to the specific population served by the plan.
- Care Coordination: SNPs typically offer care coordination services to ensure that individuals receive the coordinated care necessary to manage their conditions. This may involve case management, medication management, and assistance with navigating the healthcare system.
- Tailored Benefits: This could vary depending on the group served, but may include benefits to help cover specialty drugs and treatments for specific conditions, or extra hospital days for groups more prone to hospitalization. In addition to standard Medicare benefits, SNPs may offer extra benefits such as dental care, vision care, hearing aids, transportation services, and fitness memberships.
- Lower out-of-pocket costs: They can provide lower out-of-pocket costs by reducing cost sharing on specific prescriptions or treatments typical for the conditions covered. For example, a Chronic Special Needs Plan for Diabetes can have reduced cost sharing for diabetes supplies and prescriptions.
- Focus on Prevention: Many SNPs place a strong emphasis on preventive care and wellness programs, helping individuals manage their health and avoid costly hospitalizations.
How to Enroll in a Medicare Advantage SNP
Beneficiaries must have Medicare Part A, Part B, and meet the eligibility requirements of the Special Needs Plan. Eligibility can vary depending on the plan and group served. Not all areas have Chronic plans that cover all Medicare listed conditions, so be sure to check the plans you represent to see which conditions are covered.
Special Needs Plans typically have certain special election periods that allow beneficiaries to enroll outside of the Annual Election Period.
Beneficiaries eligible for Dual Special Needs Plans can use the DUAL/LIS Maintaining SEP once per quarter in the first 3 quarters of the year to enroll in a plan. They will also receive a Special Election Period if they have any change in the level of their Medicaid benefits.
Beneficiaries eligible for Chronic Special Needs Plans have one special election period to join a CSNP plan. The chronic special election period ends after they join a CSNP.
Beneficiaries that are institutionalized have an election period that begins the first day the client is institutionalized and ends two (2) months after the client is discharged from the facility. This election period can be used continuously. Please note: general agents cannot enroll anyone in an Institutional Special Needs Plans, but you can help them move to a new plan after they leave the facility.
In Conclusion
Medicare Advantage Special Needs Plans offer a unique opportunity for individuals with specific healthcare needs to receive tailored, comprehensive care. Whether you’re living with a chronic condition, residing in an institution, or eligible for both Medicare and Medicaid, there may be an SNP that meets your needs and enhances your overall health and well-being.
Feel free to contact us and learn more about how we can help you and your agency.
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