Medicare Special Needs Plans (SNPs) are Medicare Advantage Plans (Part C) that limit membership to people with certain diseases or characteristics. The plans' benefits, provider choices and drug coverage are all tailored to meet the needs of the specific group it serves. Patients who have Medicare Hospital Insurance (Part A) and Medicare Medical Insurance (Part B), live in the plan’s service area and meet the eligibility requirements can enroll in a Medicare SNP.
Some Medicare SNP types include Chronic Condition SNPs (C-SNP), which cover patients who have one or more severe or disabling conditions such as dementia, cancer or chronic heart failure. Beneficiaries who require nursing care at home or live in a nursing home can enroll in Institutional SNPs (I-SNP). There are also Dual Eligible SNPs (D-SNP) for patients who have both Medicare and Medicaid.
Medicare SNPs have their roots in the Medicare Modernization Act of 2003, which established a Medicare Advantage coordinated care plan to provide targeted care to patients with special needs. Congress defined “special needs individuals” as institutionalized beneficiaries, dual eligible and those with severe or disabling chronic conditions as specified by the Centers for Medicare & Medicaid Services (CMS).
The CMS must approve Medicare SNPs. These plans are run by private companies and allow beneficiaries to get all of their Medicare hospital, medical health care services and prescription drug coverage through one plan. Enrollees generally still pay the Part B premium as well as a Medicare SNP premium that covers the costs of Part A and Part B benefits.
Medicare SNPs cover all medically necessary and preventive services covered under Part A and Part B as well as prescription drugs covered by Medicare Prescription Drug Plans (Part D). SNPs might also cover extra services specific to their enrollee group.