Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that serve individuals with chronic or disabling conditions. These plans require eligible patients to receive care and services from doctors or hospitals in their Medicare SNP networks. SNP networks vary in size and the populations they serve.
Full Answer
What is a special needs plan Medicare Advantage?
Special Needs Plans. What is a Special Needs Plan? A special needs plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) specifically designed to provide targeted care and limit enrollment to special needs individuals.
What is a Medicare SNP plan?
Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that serve individuals with chronic or disabling conditions. These plans require eligible patients to receive care and services from doctors or hospitals in their Medicare SNP networks. SNP networks vary in size and the populations they serve.
How do I qualify for a Medicare special needs plan?
In order to qualify for a Special Needs Plan, you must meet each of the following criteria: 1 Be enrolled in Medicare Part A and Part B 2 Have one of the chronic conditions above, reside in a nursing home or require home nursing care or be Medicare dual-eligible 3 Reside in the plan’s service area
What does a Medicare special needs plan care coordinator do?
Some Medicare Special Needs Plans utilize a “ care coordinator .” A care coordinator is a type of personal health care assistant who helps you schedule appointments, adhere to your doctor-recommended diet and exercise plan, obtain the right prescriptions, access community resources and more. Will My Doctor Accept My Medicare Special Needs Plan?
What are the three types of special needs plans for Medicare?
There are three different types of SNPs:Chronic Condition SNP (C-SNP)Dual Eligible SNP (D-SNP)Institutional SNP (I-SNP)
What is an SNP Medicare plan?
Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
How do you qualify for CSNP?
To be eligible for a C-SNP, you must also be eligible for Medicare. C-SNPs are designed to provide people with chronic or debilitating illnesses the medical care and treatments they need, all in one plan. C-SNPs always include prescription drug coverage (Medicare Part D).
Can SNP go to any provider?
In most cases, Medicare SNPs may require you to have a primary care doctor, or the plan may require you to have a care coordinator to help with your health care. When I Join a Medicare SNP, Can I Get Health Care from Any Doctor or Hospital? No.
What is the difference between SNP and D SNP?
Institutional SNP (I-SNP): For those who live in an institution such as a nursing home or require nursing care at home. Dual-Eligible SNP (D-SNP): For those with both Medicare and Medicaid.
What is the difference between D SNP and C SNP?
C-SNPs for people with severe or disabling chronic conditions; and. D-SNPs for people who are dually eligible for Medicare (because of age and/or disability) and Medicaid (because of low income).
What is Dsnp and CSNP?
Overview. MedStar Medicare Choice Dual Advantage (HMO SNP, known as DSNP) and MedStar Medicare Choice Care Advantage (CSNP) are Medicare Special Needs Plans (SNP) that provide medical and prescription drug benefits to eligible beneficiaries.
What are most common CSNP conditions?
15 SNP-Specific Chronic Conditions:Chronic alcohol and other drug dependence.Autoimmune disorders limited to: Polyarteritis nodosa. ... Cancer, excluding pre-cancer conditions or in-situ status.Cardiovascular disorders limited to: Cardiac arrhythmias. ... Chronic heart failure.Dementia.Diabetes mellitus.End-stage liver disease.More items...•
What does HMO D SNP mean?
Dual Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual's eligibility.
What are some distinct advantages of a SNP plan?
SNPs provide helpful guidance and resources to members based on their specific condition or needs. The plan may offer extra benefits tailored to the groups it serves, such as diabetes services, care coordination or other health and wellness programs.
Do SNP plans have networks?
SNP networks vary in size and the populations they serve. Two types of networks include: Networks covering a specified area. For example, one network may cover an entire state, while another network covers one county.
What is a D SNP look alike plan?
D-SNP “look-alike” plans (sometimes called “mirror” plans) are Medicare Advantage plans that plan sponsors have designed specifcally to attract dual eligible benefciaries.
How to qualify for Medicare?
To qualify, you must have one of these three characteristics: 1 You have a chronic condition such as diabetes, heart disease, or one of 13 other ailments determined by the Centers for Medicare and Medicaid Services. 2 You can join a Chronic Condition Special Needs Plan, or C-SNP. 2 You have both Medicare and Medicaid. People who meet this qualification are referred to as “dual-eligibles” and can join plans called Dual Eligible Special Needs Plans, or D-SNPs. Not sure what the difference is? Compare Medicare vs. Medicaid. 3 You live in an institution such as a nursing home, or you require that level of care at home. You can join an Institutional Special Needs Plan, or I-SNP.
What does SNP cover?
SNPs typically cover the following: Care and services from providers in the SNP network. In most SNPs, you’ll choose a primary care doctor who will coordinate your care and give you referrals to specialists when needed. However, you can go outside the network for emergencies and urgent care needs. Prescription drugs.
What is a SNP plan?
What is a Special Needs Plan (SNP)? Special Needs Plans are one way to receive your Medicare coverage. SNPs are a type of Medicare Advantage plan, which is a health plan offered by a private insurance company that has contracted with Medicare. Medicare Advantage plans are sometimes called Part C.
How long have SNPs been around?
By grouping people in this way, the plan can provide targeted programs and support that may help them be healthier. SNPs have been around since 2006, and they have been growing steadily in recent years. In 2019, nearly three million Americans were part of Medicare Special Needs Plans. 1. There are three types of SNPs, which are explained below.
Does SNP cover Medicare?
Like all Medicare Advantage plans, SNPs must cover the same services as Original Medicare (Parts A and B). So SNPs can’t cover any less than what Original Medicare does, and usually they cover more. SNPs typically cover the following: Care and services from providers in the SNP network. In most SNPs, you’ll choose a primary care doctor who will ...
Can you get a special needs plan with Medicare?
Not everyone who meets the eligibility requirements for Medicare is eligible for a Special Needs Plan. To qualify, you must have one of these three characteristics: You have a chronic condition such as diabetes, heart disease, or one of 13 other ailments determined by the Centers for Medicare and Medicaid Services.
Is a SNP a PPO?
Like HMOs and PPOs, SNPs are a type of Medicare Advantage plan. However, SNPs are defined by who they serve, while HMOs and PPOs are defined by the types of provider networks they have and how you access them. So, a plan can be both an SNP and an HMO or PPO. 3.
What is Medicare Advantage Special Needs Plan?
A Medicare Advantage Special Needs Plan based on health conditions is a plan that is specifically designed to provide excellent support for individuals with a chronic illness. For example, the SNP might provide access to a group of providers who specialize in treating these specific illnesses. These providers work together to coordinate your care.
What is a special needs plan?
Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage plan that provides coordinated care to beneficiaries with specific needs or situation. Like all Advantage plans, Special Needs Plans will have a network, usually either an HMO or a PPO. These SNPs limit their membership to beneficiaries who have ...
What is a dual eligible special needs plan?
Dual Eligible Special Needs Plan (DSNP) Some Medicare beneficiaries also qualify for Medicaid. Medicaid is a federal and state health insurance program for people with low incomes. When you qualify for both, you can keep your Original Medicare and have Medicaid function as your secondary coverage, or you can enroll in a Dual Eligible Special Needs ...
What is an ISNP in Medicare?
Institutional Special Needs Plan (ISNP) Medicare beneficiaries who live in an institution, such as an assisted living center, nursing home, or memory care center, may qualify for an Institutional SNP. These plans are similar to the chronic illness SNP but instead focus on dealing with the provision of coordinated care to someone who is no longer ...
How to join a chronic illness SNP?
In order for you to join a Chronic Illness SNP, your doctor will have to complete a chronic condition verification form at the time of your enrollment. Your agent will provide you with the form and your doctor can complete this form and return it to verify your eligibility. Chronic Illness SNPs vary by county.
What are the conditions that qualify for SNP?
To qualify for a chronic illness SNP, you must have one or more of health conditions listed below: Autoimmune disorders. Cancer. Cardiovascular disease, stroke, or chronic heart failure. Alzheimer’s or Dementia. Diabetes. ESRD requiring dialysis. Hematologic disorders. HIV or AIDS.
What happens if you lose your SNP?
If you lose your eligibility for a SNP, you will have a grace period within which you can leave the plan and join another plan or return to Original Medicare.
What is Medicare Advantage Plan?
A Medicare Advantage Plan allows patients to receive care through a network of providers that contract with Medicare. Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that serve individuals with chronic or disabling conditions.
What does it mean to be an SNP provider?
Patients who are covered under SNPs enjoy many benefits, and becoming an SNP provider means your LTSS program would be directly involved in providing those benefits in a local, culturally appropriate setting. However, there are also challenges related to SNPs.
Do you need other forms of health insurance to be fully covered?
Patients may not need other forms of health insurance to be fully covered. Those with Medicare and Medicaid or with limited income may pay little to none of their own money for services. Networks or providers may not be available in all parts of the country.
How to qualify for a special needs plan?
In order to qualify for a Special Needs Plan, you must meet each of the following criteria: Be enrolled in Medicare Part A and Part B. Have one of the chronic conditions above, reside in a nursing home or require home nursing care or be Medicare dual-eligible. Reside in the plan’s service area. A Chronic Condition SNP will require a note ...
What is special needs insurance?
Special Needs Plans are a type of Medicare Advantage plan. Medicare Advantage plans are a form of private Medicare coverage. These plans, sold by private insurance companies, offer all the same benefits as Original Medicare (Part A and Part B).
What is a SNP plan?
Your Complete Guide to Medicare Special Needs Plans (SNP) A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage plan (Medicare Part C) that is designed to fit the health care needs of people with a certain health condition or circumstance.
When does Medicare AEP take place?
The Medicare AEP takes place every year from October 15 to December 7. Special Enrollment Period (SEP) You may be granted a Special Enrollment Period at any time throughout the year, depending on your circumstances.
When does Medicare enroll in AEP?
Annual Enrollment Period (AEP) The Medicare AEP takes place every year from October 15 to December 7.
What is a care coordinator in Medicare?
A care coordinator is a type of personal health care assistant who helps you schedule appointments, adhere to your doctor-recommended diet and exercise plan, obtain the right prescriptions, access community resources and more.
What is an I-SNP?
Institutional Special Needs Plans (I-SNP) These plans are for people who are institutionalized in a nursing home or require nursing care at home. Chronic Condition Special Needs Plans (C-SNP) There are 15 different health conditions that may have a corresponding Medicare Special Needs Plan: Chronic alcohol and drug dependence.
What is a Medicare Special Needs Plan?
A Medicare Special Needs plan is a type of Medicare Advantage Plan available only to people who have certain qualifying health conditions or situations.
Who can join an SNP?
Anyone who is eligible for Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), lives in the plan’s service area, and meets the plan’s eligibility requirements can join an SNP.
What are the different types of SNP plans and eligibility requirements?
There are several kinds of SNPs, and to be eligible to sign up, enrollees must meet the qualifications for at least one of these:
How does a Medicare SNP work?
Medicare SNPs must provide you with the same benefits as Original Medicare, but they usually offer more help and covered benefits than Original Medicare or other Medicare Advantage plans. This additional care includes:
How much do SNP plans cost?
That depends. SNPs generally don’t cost more than other Medicare Advantage plans. But because some SNPs offer additional care, they may charge a monthly premium in addition to the base premium.
Can I get my healthcare from any doctor or network?
Usually, you need to stay in the Medicare SNP network, which is generally geared toward your specific needs or condition. There are two exceptions, however:
What questions should I ask before I enroll in an SNP?
Just as you would before joining any plan, your questions should be geared toward your individual needs. Here are some examples of things to ask to help you narrow down your choices.
What is a special needs plan?
A special needs plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) specifically designed to provide targeted care and limit enrollment to special needs individuals. A special needs individual could be any one of the following: An institutionalized individual, A dual eligible, or. An individual with a severe or disabling chronic ...
Why do SNPs need to provide Part D coverage?
All SNPs must provide Part D prescription drug coverage because special needs individuals must have access to prescription drugs to manage and control their special health care needs. SNPs should assume that, if no modification is contained in guidance, existing Part C and D rules apply.
What is SNP in healthcare?
A SNP may be any type of MA CCP, including either a local or regional preferred provider organization (i.e., LPPO or RPPO) plan, a health maintenance organization (HMO) plan, or an HMO Point-of-Service (HMO-POS) ...
When did the SNP program end?
Most recently, section 206 of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended the SNP program through December 31, 2018.
Do SNPs have to submit bids?
SNPs must prepare and submit bids like other MA plans, and are paid in the same manner as other MA plans based on the plan’s enrollment and risk adjustment payment methodology. All SNPs must abide by current CMS guidance on cost sharing requirements.
Do SNPs have to follow Medicare?
SNPs are expected to follow existing MA program rules, including MA regulations at 42 CFR 422, as modified by guidance, with regard to Medicare- covered services and Prescription Drug Benefit program rules. All SNPs must provide Part D prescription drug coverage because special needs individuals must have access to prescription drugs to manage and control their special health care needs. SNPs should assume that, if no modification is contained in guidance, existing Part C and D rules apply.
Did CMS accept SNP applications in 2008?
Accordingly, CMS did not accept SNP applications in 2008 for contract year (CY) 2009. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) lifted the Medicare, Medicaid, and SCHIP Extension Act of 2007 moratorium on approving new SNPs.
What are the three types of Medicare special needs plan?
The three types of special needs plan serve different groups of people:
Who's eligible to join a SNP?
By law, Medicare SNPs are not available to just anybody. You can enroll in a SNP only if:
How are these plans different from typical Medicare Advantage plans?
All Medicare Advantage plans provide hospitalization benefits and coverage of necessary medical services; some plans — including some SNPs — also offer vision, hearing, and dental care. But SNPs are different, because their benefits are specifically focused on plan members’ personal circumstances.
How much do Medicare special needs plans cost compared to original Medicare?
The cost of an SNP, as with all Medicare Advantage plans, reflects its plan type and benefits.
How do you enroll in a Medicare special needs plan?
Normally, if you meet the requirements for a SNP, you can join it during the regular Medicare Advantage open enrollment period from January 1 to March 31 each year. However, the situation that made you eligible for the SNP may also qualify you to have a special enrollment period (SEP).
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The bottom line
Medicare Advantage special needs plans focus on coordinating care for three different groups: people with specific chronic illnesses, people who qualify for both Medicare and Medicaid, or people who need institution-level nursing care. Membership is limited to people with these conditions or in these situations.
