Full Answer
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 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.
How do I submit an SNP application for Medicare Advantage?
All SNP applications must be submitted electronically through the Health Plan Management System (HPMS) to CMS by the SNP application due date. The MA application and the SNP application for the current contract year are available at the below link to the Medicare Advantage Applications website.
How many special needs plans are available?
As of May 2019, there are a total of 734 Special Needs Plans available throughout the U.S. 1 The breakdown of those plans is as follows: 480 D-SNPs 129 C-SNPs 125 I-SNPs
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).
What levels of Medicaid dual eligibility usually qualify for a D SNP select all that apply?
Dual-eligibles, individuals of any age who are eligible for both Medicare and Medicaid, qualify for D-SNPs. To be eligible for Medicare, individuals must be 65 years old or older or have a qualifying disability....Who Qualifies for D-SNPs?Type of D-SNPWho's Eligible to EnrollAll-DualAny dual-eligible beneficiary4 more rows
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 a dual eligible Special Needs Plan D-SNP )?
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 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.
Does COPD qualify for C SNP?
Chronic lung disorders These C-SNPs offer special care for those with lung-related disorders such as chronic obstructive pulmonary disease (COPD), asthma, chronic bronchitis, pulmonary hypertension, or emphysema.
What is an Iesnp?
What Is an I-SNP? Institutional Special Needs Plans (I-SNPs) are a type of Medicare Advantage plan. I-SNPs are designed to meet the needs of people living in long-term care settings, [i] such as: long-term care nursing facility.
What is the difference between Dsnp and MMP?
This includes providing beneficiaries with a seamless enrollment and disenrollment process and access to high-quality integrated healthcare. MMPs differ from SNPs in that they are a totally aligned product designed to further strengthen the coordination of Medicare and Medicaid Services.
Is D SNP a Medicare Advantage plan?
Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage (MA) health plans which provide specialized care and wrap-around services for dual eligible beneficiaries (eligible for both Medicare and Medicaid).
Can you have Medicare and Medicaid at the same time?
Yes. A person can be eligible for both Medicaid and Medicare and receive benefits from both programs at the same time.
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 ...
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 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.
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).
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.
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 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 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.
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.
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.
SNPs are part of Medicare Advantage
Special needs plans are Medicare Advantage plans tailored for specific medical concerns.
SNPs limit enrollment and benefits around specific concerns or chronic condition
A SNP provides a specific list of available providers and services, depending on the Medicare beneficiary's condition. For example, if you have an autoimmune disorder or a mental health condition, your SNP could cover services like home health care or behavioral health services.
If you need long-term nursing care, you might qualify for a SNP
If you’re planning to receive long-term nursing care, whether at home or in a facility, you may qualify for an SNP. You also qualify if you receive both Medicare and Medicaid services or if you have any chronic conditions, including chronic heart disease or diabetes, that require long-term care. According to The Official U.S.
What is a special needs plan?
Answer: A Special Needs Plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) designed to provide targeted care and services to individuals with unique needs.1 "Special needs individuals" have been defined as: 1) institutionalized beneficiaries; 2) Medicare-Medicaid enrollees; and/or, 3) individuals with severe or disabling chronic conditions, as specified by the Centers for Medicare and Medicaid Services (CMS).2
What is a dual eligible special needs plan?
Answer: Dual Eligible Special Needs Plans (D-SNPs) are SNPs that enroll beneficiaries who are entitled to both Title XVIII (Medicare) and Medical Assistance from a State/Territorial plan under Title XIX (Medicaid) of the Social Security Act (the Act). There are five categories of D-SNPs, according to the types of beneficiaries34 that can enroll:
What is dual eligible?
Answer: “Dual eligible” is a term used to encompass all Medicare beneficiaries who also receive Medicaid assistance, ranging from beneficiaries who receive the full range of Medicaid benefits to beneficiaries who receive assistance only with Medicare premiums or cost sharing. Dual eligible coverage is dependent on beneficiaries’ income and asset thresholds.37
What is SEP in CMS?
Answer: CMS provides a Special Enrollment Period (SEP) for individuals enrolled in an SNP, but are no longer eligible because they no longer meet the specific special needs status.9 SNPs must send the appropriate notice to the beneficiary explaining their disenrollment.10
How long does an I-SNP stay in hospital?
Answer: An I-SNP can enroll an individual prior to having at least 90 days of institutional level care if the I-SNP completes a CMS-approved needs assessment showing that the individual’s condition makes it likely that either the length of stay or the need for an institutional level-of-care will be at least 90 days.54
What is the payment procedure for SNPs?
Answer: Payment procedures for SNPs mirror the procedures that CMS uses to make payments to non-SNP MA plans. CMS makes advance monthly payments, or capitated payments, to an MA organization for each enrollee for coverage of original Medicare benefits in an MA payment area.3
How to determine eligibility for a C-SNP?
Answer: To determine eligibility for a special needs individual to enroll in a C-SNP, CMS requires that the C-SNP contact the applicant's existing provider to verify the enrollee has the qualifying conditions. C-SNPs must reconfirm a beneficiary's eligibility at least annually.
List of Chronic Conditions
Section 1859 (b) (6) (B) (iii) of the Act and 42 CFR 422.2 define special needs individuals with severe or disabling chronic conditions as special needs individuals “who have one or more co-morbid and medically complex chronic conditions that are substantially disabling or life threatening; have a high risk of hospitalization or other significant adverse health outcomes; and require specialized delivery systems across domains of care.” CMS solicited public comments on chronic conditions meeting the clarified definition and convened the SNP Chronic Condition Panel in the fall of 2008.
Grouping Chronic Conditions
When completing the SNP application, MAOs may apply to offer a C-SNP that targets any one of the following:
CMS-Approved Group of Commonly Co-morbid and Clinically-Linked Conditions
A C-SNP may not be structured around multiple commonly co-morbid conditions that are not clinically linked in their treatment because such an arrangement results in a general market product rather than one that is tailored for a particular population.
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…