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Explore Medicare Special Needs Plans (SNPs)

Read on for help finding the right SNP for you, including Dual Eligible Special Needs Plans from Healthcareplans.com.

Medicare Special Needs Plans (SNPs) offer the same Medicare Part A & B coverage that most Medicare Advantage plans cover, but are only available to those who meet certain special qualifications. SNPs may also offer additional benefits.

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Types of Medicare Special Needs Plans (SNPs)

There are three types of Special Needs Plans (SNPs) available for those eligible. However, at Healthcareplans.com, we offer only one of the three types: the Dual Eligible Special Needs Plan, or D-SNP.

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Dual Eligibility SNPs (D-SNPs)

Dual Eligible Special Needs Plans are available to those eligible for both Medicare and Medicaid. D-SNPs contract with state Medicaid programs to coordinate Medicare and Medicaid benefits and provide equivalent coverage to the Original Medicare benefits of most Medicare Advantage plans. They also provide additional benefits that may include a monthly stipend, prescription drug coverage, dental coverage, and/or medical transportation costs. D-SNPs usually have low or $0 monthly plan premiums.

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Chronic Condition SNPs (C-SNPs)

Chronic Condition Special Needs Plans (C-SNPs) are available for those eligible for Original Medicare (Medicare Parts A & B) who have one or more eligible severe or disabling chronic conditions. See the comprehensive list below for eligible conditions.

For more information or to find a carrier providing C-SNPs, check out CMS.gov.
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Institutional SNPs (I-SNPs)

Institutional Special Needs Plans (I-SNPs) are available for those eligible for Original Medicare (Medicare Parts A & B) who need the level of care a professional facility offers, or live/are expected to live for at least 90 days in a residential health care facility.

For more information or to find a carrier providing I-SNPs, check out CMS.gov.

Compare Medicare SNP coverage

CoverageD-SNPC-SNPI-SNP
Charges monthly premiumSome plansSome plansSome plans
Offers prescription drug (Part D) coverageYesYesYes
Requires primary care doctorSome plansSome plansSome plans
Requires specialist referralsSome plansSome plansSome plans
Offers out-of-network coverageSome plansSome plansSome plans

Who is eligible for a Medicare SNP?

Each Medicare Special Needs Plan has different eligibility requirements. However, for any Special Needs Plan, you must have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and live in the plan’s service area.

D-SNP eligibility requirements:

For a Dual Eligible Special Needs Plan (D-SNP), you must qualify for both Medicare and Medicaid.

  • Medicare eligibility:
    • By age: If you are a United States citizen who has been living in the U.S. for the past 5 years and are 65 years of age (or nearing your 65th birthday), you are eligible for Original Medicare (Parts A & B).
    • By special circumstance: Some disabilities and conditions may qualify you for Medicare coverage before age 65:
      • If you are disabled and have received Social Security benefits for at least 24 consecutive months
      • If you suffer from kidney failure, also known as End-Stage Renal Disease (ESRD), and have had a kidney transplant or been on dialysis for 3 months
      • If you have amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease)
  • Medicaid eligibility:
    • If you are eligible under one of the following Medicaid categories, you qualify for a D-SNP:
      • Full Medicaid
      • Qualified Medicare Beneficiary (QMB) without other Medicaid
      • QMB Plus
      • Specified Low-income Medicare Beneficiary without other Medicaid (SLMB)
      • SLMB Plus
      • Qualifying Individual (QI)
      • Qualified Disabled and Working Individual (QDWI)

C-SNP eligibility requirements:

To qualify for a Chronic Condition SNP (C-SNP) you must have one or more of the following severe or disabling chronic conditions:

  • Chronic alcohol dependence
  • Chronic drug dependence
  • Certain autoimmune disorders
  • Cancer (excluding preexisting cancer conditions)
  • Certain cardiovascular disorders
  • Chronic heart failure
  • Dementia
  • Diabetes mellitus
  • End-stage liver disease
  • End-Stage Renal Disease (ESRD) requiring dialysis
  • Certain severe hematologic disorders
  • HIV/AIDS
  • Certain chronic lung disorders
  • Certain chronic and disabling mental health conditions
  • Certain neurologic disorders
  • Stroke

I-SNP eligibility requirements:

To qualify for an Institutional Special Needs Plan (I-SNP) you must live or expect to live for at least 90 days in a residential health care facility such as the following.

  • Nursing home
  • Intermediate care facility
  • Rehabilitation hospital
  • Long-term care hospital
  • Swing-bed hospital
  • Psychiatric hospital
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Frequently asked questions about Medicare Special Needs Plans

How do I enroll in a SNP?

If you are eligible for a Special Needs Plan, research plans online and shop during a qualifying enrollment period. At Healthcareplans.com, you can use our tools to shop for Dual Eligible Special Needs Plans only; to find resources for C-SNP and I-SNP carriers, visit CMS.gov.

When do I enroll in a SNP?

If you are qualified for a Special Needs Plan, enroll during the following qualified Medicare Enrollment Periods:

  • Annual Enrollment Period - October 15–December 7 each year, available to anyone Medicare-eligible. You can enroll in, drop, or switch Medicare Special Needs Plans during this period.
  • Initial Enrollment Period - If you are eligible for a Special Needs Plan, you can enroll during IEP, which begins three months before you turn 65, includes the month you turn 65, and ends three months after your 65th birthday month. 
  • D-SNP Special Enrollment Periods - Special Enrollment Periods for Dual Eligible Special Needs Plans differ from those associated with other plan changes. Since 2019, those who qualify for a D-SNP can use a Special Enrollment Period to change their D-SNP once every three months for the first nine months of the year:
    • January 1–March 31
    • April 1–June 30
    • July 1–September 30
  • C-SNP Special Enrollment Periods - You may be eligible for a C-SNP Special Enrollment Period if you are diagnosed with one of the qualifying conditions listed above.
  • I-SNP Special Enrollment Periods - You may be eligible for an I-SNP Special Enrollment Period if you are entering a qualified SNP coverage institution or develop the need for residential-level care

Do SNPs charge a monthly premium?

Special Needs Plan costs vary by carrier and location, but many SNPs feature low or $0 monthly premiums, copays, and deductibles. For D-SNPs specifically, Medicaid benefits from the state generally cover most or all of your out-of-pocket costs.

Do I need to pick a primary care physician (PCP)?

Plans from some carriers require you to choose a primary care physician and others do not. It will depend on the carrier and specific plan you choose; be sure to check before you sign up.

Do I have to get a referral to see a specialist?

Plans from some carriers require you to have specialist referrals and others do not. It will depend on the carrier and specific plan you choose; be sure to check before you sign up.

Can I choose a separate Medicare Advantage (Part C plan) with my SNP?

The coverage provided by your Special Needs Plan is equivalent to the coverage you’d get with a Medicare Advantage (Part C) plan; there is no need to enroll in a separate plan.

Medicare resources

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General Enrollment and Open Enrollment Periods

Learn about the two Medicare enrollment periods that run from January through March.

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Medicare Annual Enrollment Period 101

When is the Medicare Annual Enrollment Period? Get answers to this and other AEP-related questions.

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Medicare Enrollment Overview

Get fast facts about Medicare Enrollment, including when you qualify and when to enroll.

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