What is a SNP in Medicare?
Each Medicare SNP is designed to offer some unique benefits designed to serve the population for whom that plan is designed. For example, a Medicare SNP for beneficiaries who have a chronic lung disorder may include: A network of providers who specialize in treating lung conditions.
What is a SNP plan?
A Medicare SNP, or Special Needs Plan, is a type of Medicare Advantage plan tailored to the needs of specific health conditions or circumstances. Learn more about what a Medicare Advantage SNP might cover, how these plans typically work and how and when you can enroll in an SNP plan. Medicare Advantage plans called Special Needs Plans (SNP) ...
What is Medicare Advantage?
Medicare Advantage plans offer an alternative way to receive Original Medicare benefits (Part A and Part B), and many Medicare Advantage plans offer additional benefits that aren't covered by Original Medicare. Medicare Advantage plans come in a variety of types such as HMOs and PPOs. While Original Medicare can be used all over the country, ...
Is Medicare Advantage the same as Medicare Part A?
As mentioned above, Medicare Advantage plans offer the same benefits covered by Medicare Part A and Part B combined into one plan sold by a private insurance company. Medicare Advantage Special Needs Plans can also cater more specifically to the needs of people with: Dependence issues with alcohol or other substances. Autoimmune disorders.
What is Medicare Advantage Special Needs?
Medicare Advantage Special Needs Plans can also cater more specifically to the needs of people with: There also Special Needs Plans that can be available to people who reside in a long-term care facility such as a skilled nursing home.
Does Medicare cover ESRD?
Medicare Special Needs Plans also generally feature a list of covered prescription drugs that are commonly used to treat your specific condition. While most Medicare Advantage plans include prescription drug coverage, all Special Needs Plans are required to include this benefit. Coverage for ESRD.
What is a special needs plan?
A Special Needs Plan is a type of Medicare Advantage plan (also called Medicare Part C) that is designed specifically for someone with a particular disease or financial circumstance. The coverage offered by each SNP is built around providing more narrowly-focused care that better meets the needs of the patient.
Why is Medicare SNP important?
Because Medicare SNP plans are created with special needs in mind, they generally go beyond providing the same level of coverage as Original Medicare Parts A and B, offering benefits that are specifically tailored to their enrollees’ conditions or circumstances . The targeted services that are offered are formulated to complement the regimens and requirements of the beneficiaries. This both improves treatment and minimizes frustrations and costs that may be encountered in other Medicare Advantage plans that serve a more general patient population.
What are the drawbacks of Medicare SNP?
Though Medicare SNP plans are designed to provide special services to those Medicare beneficiaries that need them, there are some drawbacks to the programs. The SNP plans frequently require their enrollees to see physicians and use providers that are part of pre-established networks, and this may preclude you from remaining with your existing physician. You also may need to get referrals to see specialists. The programs are not widely available, and those who believe they are qualified in the programs must meet specific SNP eligibility criteria. Beneficiaries may be disenrolled when their status changes and they no longer meet the criteria, and will then need to enroll in another plan. Though, if a beneficiary is disenrolled they will have a Special Enrollment Period to join another Medicare Advantage plan.
How long do you have to live in a nursing home to qualify for SNP?
To qualify for an Institutional Special Needs Plan, you must live in long-term care served by the SNP for a minimum of 90 days. To qualify, the facility can be either a nursing home or an intermediate care facility for those with intellectual disabilities. Alternatively, you must have met your state’s guidelines for requiring a nursing home-level of care for a minimum of 90 days whether you live in a community setting such as your home or a group residence or in an institution. Those who have not yet received care for at least 90 days but who are likely to need that level of care for that period of time can also qualify.
How to qualify for dual SNP?
To qualify for a Dual Eligible Special Needs Plan, you need to provide proof that you have Medicaid. This can be accomplished either by producing a letter from Medicaid or showing your Medicaid identification card. Alternatively, you can complete the enrollment form for the D-SNP and the plan administrator will verify your Medicaid status. It is important to note that if you are enrolled in a Medicare MSP (Medical Savings Plan) at the time that you apply for a Dual Eligible Special Needs Plan, you may find that the specific plan does not accept MSP beneficiaries to enroll. Most D-SNPs include a high level of dental, vision, and hearing care, as well as many other benefits.
Who is Caren Lampitoc?
Caren Lampitoc is an educator and Medicare consultant for Medicare Risk Adjustments and has over 25 years of experience working in the field of Medicine as a surgical coder, educator and consultant.
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 ...
What is a dual eligible plan?
A dual eligible, or. An individual with a severe or disabling chronic condition, as specified by CMS. 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) plan.
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.
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.
What is a special needs plan?
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.
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.
Institutional Equivalent SNPs
For an I-SNP to enroll MA eligible individuals living in the community, but requiring an institutional level of care (LOC), the following two conditions must be met:
Change of Residence Requirement for I-SNPs
If an I-SNP enrollee changes residence, the I-SNP must document that it is prepared to implement a CMS-approved MOC at the enrollee’s new residence, or in another I-SNP contracted LTC setting that provides an institutional level of care.
Medicaid Eligibility Categories
The Medicaid eligibility categories encompass all categories of Medicaid eligibility including:
D-SNPs With or Without Medicare Zero-Dollar Cost Sharing
At the time of plan creation, each D-SNP must identify whether or not if offers Medicare zero-dollar cost sharing. In HPMS, D-SNPs will have the option of one of the following two indicators:
What is DSNP in Medicare?
What is a DSNP? For millions of Americans who qualify as dual-eligible healthcare beneficiaries, trying to coordinate their health care with both Medicare and Medicaid services can be confusing. For this reason, there are Special Needs Plans from Medicare Advantage that provide you with a convenient way to manage your healthcare services ...
What is a dual eligibility plan?
People who have dual eligibility status can sign up for a type of Special Needs Plans known as a Dual-eligible Special Needs Plan, or DSNP. DSNPs are specialized Medicare Advantage plans that provide healthcare benefits for beneficiaries that have both Medicare and Medicaid coverage. Most DSNPs are categorized as either HMOs (Health Maintenance ...
How old do you have to be to qualify for Medicare?
• You must be 65 years old or have a qualifying disability if younger than 65.
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: 1. An institutionalized individual, 2. A dual eligible, or 3. An individual with a severe or disabling chr...
Statutory and Regulatory History
- The Medicare Modernization Act of 2003 (MMA) established an MA CCP specifically designed to provide targeted care to individuals with special needs. In the MMA, Congress identified “special needs individuals” as: 1) institutionalized individuals; 2) dual eligibles; and/or 3) individuals with severe or disabling chronic conditions, as specified by CMS. MA CCPs established to provide se…
Requirements and Payment Procedures
- 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 c…
Site Overview
- Specific information about each of the three SNP types (C-SNPs, D-SNPs, and I-SNPs), as well as information on the SNP Application and the SNP Model of Care, can be found by clicking the appropriate links on the left-hand side of this page. In addition, there is a link below to the online Medicare Managed Care Manual, which contains Chapter 16b – CMS's current sub-regulatory gu…