Understanding what Special Needs Plans (SNPs) offer

If you are considering a Special Needs Plan (SNP), it's important to understand its offerings and qualification criteria. A SNP is a type of Medicare Advantage plan that includes all the coverage of Original Medicare, along with extra benefits tailored to help manage specific health needs. 

A special needs enrollee could be a dual eligible, someone living with a severe or disabling chronic condition, an assisted living resident, or a person meeting nursing facility level of care state requirements.

SNPs often provide enhanced care coordination, prescription drug coverage, and access to specialized providers. SNPs might also cover extra services specific to the members they serve. For example, if you have diabetes and require certain supplies, a SNP may cover popular insulins and offer rewards for taking healthy activities, like getting an A1C screening. Enrollees can only remain in a SNP if they continue to meet the conditions of the plan.

There are three different types of SNPs:

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

Chronic Condition Special Needs Plan (C-SNP)

C-SNPs are a type of Medicare Advantage plan designed to support the needs of individuals living with one or more severe or disabling chronic conditions. The types of C-SNPs vary from health plan to health plan. You will need to check directly with the health plan provider to see if they offer one that meets your specific healthcare needs.

Chronic conditions may include:

• Autoimmune disorders
• Cardiovascular disorders
• Chronic and disabling mental health conditions
• Chronic heart failure
• Chronic lung disorders
• Diabetes
• End-stage liver or renal disease
• Neurologic disorders

SNPs provide benefits and services to people living with specific conditions, certain healthcare needs, or who also have Medicaid.

Dual Eligible Special Needs Plan (D-SNP)

If you are eligible for both Medicare and Medicaid, you can choose a Dual Eligible Special Needs Plan for your Medicare health coverage. A D-SNP is a Medicare Advantage plan that works with your state’s Medicaid health plan. If you are enrolled in a D-SNP, you will have no premiums or copays for doctor or specialist visits. You may have copays for prescription drugs.

Is a D-SNP right for you?

If you are eligible for Medicare, either by age or by disability, and get help from Medicaid, you may qualify for a Dual Eligible Special Needs Plan. You must also enroll in Medicare Parts A and B and live in the health plan's service area.

Eligible for Medicare but not full Medicaid?

Some people are partial dual-eligible. They may qualify for Extra Help, a federal program that helps low-income Medicare enrollees to cover their Part D prescription costs. Partial dual eligible enrollees may qualify for Extra Help even if they aren't eligible for full Medicaid benefits through a Cardinal Care Managed Care health plan.

To enroll in a partial D-SNP, members must qualify for some level of Medicaid benefits, like through a Medicare Savings Program (MSP) such as Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), or Qualified Individual (QI), but do not receive full Medicaid benefits. They must also have Medicare Part A and Part B coverage and live within the service area.

D-SNP extra benefits may include:

• A grocery allowance 
• A prepaid flex card to use toward utilities and other bills
• Prescription drug coverage
• Over-the-counter (OTC) products allowance
• Dental cleanings and services
• Vision exam and allowance for glasses or contacts
• Hearing exam and hearing aids

Institutional Special Needs Plan (I-SNP)

I-SNPs are designed to meet the needs of people currently receiving, or expected to need, the level of services provided in a long-term care facility for 90 days or longer.

If you are interested in an I-SNP and live in a facility, check to see if the health plan has providers that serve people where you live. Institutional special needs plans are designed for those who are eligible for Medicare Advantage and have had, or are expected to need, one of these long-term care services provided for 90 days or longer.

• Long-term care (LTC) skilled nursing facility (SNF)
• Long-term care (LTC) nursing facility (NF)
• Skilled nursing facility/nursing facility (SNF/NF)
• Intermediate care facility (ICF) for those living with intellectual disabilities (IDD)
• Inpatient psychiatric facility

An I-SNP offers a coordinated approach to healthcare by providing comprehensive medical and support services in one location. This streamlined access can significantly reduce the need for travel for preventive care, like vaccinations and screenings. Additionally, it can lead to less emergency room visits and stressful hospital stays, ultimately promoting a more efficient and supportive healthcare journey.

In summary, C-SNPs cater to individuals with severe or disabling health conditions, D-SNPs are designed for people eligible for both Medicare and Medicaid, and I-SNPs serve residents of long-term care facilities. All SNPs include a care coordinator who helps manage your health and collaborates with you to develop a personalized care plan.

You can stay enrolled in a Medicare SNP only if you continue to meet the conditions served by the health plan. If you are currently getting treatment and you switch to a new health plan, you’ll have at least 90 days before the new health plan can ask you to get a new prior approval for your ongoing treatment. Check with the health plan you’re interested in for specific information. If you lose your health plan because you no longer meet the plan's conditions, you may be eligible for a Special Enrollment Period to join another plan.

Enrollment periods

Frequently asked questions and answers

Do SNPs charge a monthly premium?

• It varies by plan.
• Some plans may charge a premium in addition to the monthly Part B (medical insurance) premium. If you have Medicare and Medicaid, most costs will be fully covered.

Can I use any doctor or hospital that accepts Medicare for covered services?

• It varies by plan.
• Some SNPs require you to get your care and services from providers and facilities within the plan’s network. Exceptions may include emergency care, out-of-area urgent care, or out-of-area dialysis.
• You can get out-of-network services from any qualified provider or facility with some SNPs, but it will usually cost more.

Do I need a referral to see a specialist?

• It varies by plan.

What’s the difference between D-SNP and FIDE SNP?

• Fully integrated D-SNPs (FIDE SNPs) are D-SNPs that provide coverage from a Medicare managed care plan that coordinates all covered Medicare and Medicaid benefits in one health plan.

>If you or a loved one are living with complex healthcare needs or limited income, call one of our Licensed Plan Advisors to see if you are eligible for a Sentara Medicare special needs plan.

We’re available October 1 through March 31, 7 days a week, from 8 a.m. to 8 p.m., or April 1 through September 30, Monday through Friday, from 8 a.m. to 8 p.m.

Sources: cms.gov, dmas.virginia.gov, medicare.gov

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