A Special Needs Plan, or SNP, is a Medicare Advantage plan designed for a defined group of people. It includes care coordination and requires more than simply having Medicare. You must have Parts A and B, live in the plan’s service area and meet that plan’s specific eligibility requirements.
The three types
| Type | Who it is designed for | What to verify |
|---|---|---|
| D-SNP: Dual Eligible | People who have both Medicare and qualifying Medicaid coverage | Your Medicaid category and the categories accepted by the specific plan |
| C-SNP: Chronic Condition | People with certain qualifying severe or disabling chronic conditions | Whether your condition meets the plan’s criteria and what verification is required |
| I-SNP: Institutional | People meeting specified institutional or institutional-equivalent care requirements | The plan’s eligibility assessment and whether its providers serve your setting |
A diagnosis or Medicaid card alone does not establish eligibility for every SNP. The plan must confirm that you meet its conditions. Availability differs by location and year.
What coverage does an SNP include?
SNPs cover the Medicare Part A and Part B benefits required of Medicare Advantage plans and include Part D coverage. Benefits and care coordination are organized around the population the plan serves. Additional benefits, costs and provider access vary; a benefit offered by one SNP is not a promise about another.
Questions to ask before enrolling
- What proof is needed to confirm my eligibility?
- Are my current doctors, hospitals and care facilities in the exact plan’s network?
- Will I need a primary care provider, referrals or prior authorization?
- What premiums and cost sharing apply to my circumstances?
- How do I reach the care coordinator when I need help organizing covered services?
- Which enrollment period applies, and when would coverage begin?
If you have Medicare and Medicaid
A D-SNP can help coordinate these programs, but enrolling in it is not the same as receiving Medicaid approval. The state Medicaid agency determines Medicaid eligibility. Ask the plan how it coordinates with your existing Medicaid coverage and providers before changing either arrangement.
If your circumstances change
You must continue to meet the plan’s special eligibility conditions. If your status changes, contact the plan and read any notices promptly. A loss of eligibility can affect enrollment and may create a Special Enrollment Period for other coverage. Confirm the specific dates rather than waiting for the next annual enrollment period.
Is an SNP automatically the right choice?
No. Eligibility creates an option, not a recommendation. Compare the network, care coordination, costs and benefits with the other choices available to you. The plan documents and its eligibility determination should support your decision.