If you’re looking into Medicare Advantage plans, you’re smart to include Special Needs Plans (SNPs) in your search. While not everyone can be a part of one, SNPs can provide tailored benefits to those who are eligible for them.

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. If you need a refresher on Medicare overall, start with our Medicare 101 Guide.

The basic philosophy of SNPs is to provide benefits to a group of enrollees that share a specific medical condition or other characteristic. 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.

Who can join a Medicare Special Needs Plan?

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.2 You can join a Chronic Condition Special Needs Plan, or C-SNP.
  • 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.
  • 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’s the difference between SNPs and HMOs/PPOs?

This is kind of a trick question. 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 does an SNP cover?

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 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. On an SNP, the list of covered drugs (called a formulary) is tailored to the health conditions of those on the plan. If you join an SNP, you don’t need to purchase a separate Medicare Part D prescription plan.4
  • Additional items not covered by Original Medicare. Plans can include vision, hearing, and dental care; wellness programs like gym memberships or the Silver Sneakers program; or a care coordinator to help you manage your condition.

Some plans also cover transportation to appointments, over-the-counter medicine, and adult day-care services.5

How to enroll in an SNP

Fortunately, joining an SNP is pretty simple. If you qualify for Medicare and match the characteristics for an SNP plan, you can apply anytime. You don’t need to wait for the various open enrollment periods that Medicare has throughout the year.

What are the pros and cons of SNPs?

Pros

  • Are available to join anytime if you qualify
  • Offer care and programs targeted to your needs
  • Offer coverage for vision, dental, and hearing
  • Include a prescription drug plan

Cons

  • Are not offered in all areas
  • Have a network of providers you must use
  • Require referrals to see specialists

The bottom line

Special needs plans can be a great resource for those who qualify for them. You can join an SNP if you have certain chronic conditions, require care from a nursing home, or are eligible for both Medicare and Medicaid.

As a type of Medicare Advantage plan, SNPs offer additional coverage compared to Original Medicare, such as vision, dental, and hearing coverage. Also, SNPs are tailored to offer the benefits, provider networks, and medications their members need most.

Think a Medicare SNP might be right for you? Read our reviews of some of the most popular Medicare Advantage providers. If you’re still not sure whether a Medicare SNP is right for you then learn more about Medicare PPO, HMO, and PFFS plans.

Sources: 

1. Kaiser Family Foundation, “A Dozen Facts about Medicare Advantage in 2019

2. CMS.gov, “Chronic Condition Special Needs Plans

3. CMS.gov, “Special Needs Plans

4. Medicare.gov, “Special Needs Plans (SNP)

5. CMS.gov, “Medicare Advantage Plans Cover All Medicare Services