Special Needs Plans (SNPs)
Medicare Advantage Special Needs Plans provide targeted, tailored coverage for people with specific conditions, dual Medicare-Medicaid eligibility, or institutional care needs. Get the specialized benefits and care coordination you deserve.
What Are Special Needs Plans?
Special Needs Plans (SNPs) are a type of Medicare Advantage plan specifically designed to serve Medicare beneficiaries who have particular health conditions, financial circumstances, or care settings. Unlike standard Medicare Advantage plans that are open to all Medicare-eligible individuals, SNPs limit enrollment to people who meet specific criteria.
Because SNPs serve a targeted population, they are able to provide highly tailored benefits, provider networks, drug formularies, and care management programs. Every SNP enrollee receives a personalized Model of Care — a comprehensive care plan developed by a team of healthcare professionals that addresses your individual needs and coordinates all of your services.
SNPs include all the benefits of Original Medicare (Part A and Part B) plus Part D prescription drug coverage. Most also offer additional benefits like dental, vision, hearing, transportation, and wellness programs. There are three types of SNPs, each designed for a different group of beneficiaries.
Types of Special Needs Plans
D-SNP: Dual Eligible Special Needs Plans
For people with both Medicare and Medicaid
D-SNP plans are designed for beneficiaries who qualify for both Medicare and Medicaid. These plans coordinate benefits between both programs, often resulting in very low or $0 out-of-pocket costs. D-SNPs typically include extra benefits like dental, vision, hearing, transportation to medical appointments, over-the-counter allowances, and meal delivery services. They are the most common type of Special Needs Plan.
Who qualifies:
- Full-benefit dual eligible (Medicare + full Medicaid)
- Partial-benefit dual eligible (Medicare + partial Medicaid assistance)
- Qualified Medicare Beneficiaries (QMB)
- Specified Low-Income Medicare Beneficiaries (SLMB)
- Qualifying Individuals (QI)
C-SNP: Chronic Condition Special Needs Plans
For people with specific chronic health conditions
C-SNP plans serve beneficiaries who have one or more qualifying severe or disabling chronic conditions. These plans are built around managing your specific condition with specialized provider networks, disease management programs, and care coordination. Benefits and formularies are tailored to the covered conditions, ensuring you get the medications and services most relevant to your health needs.
Who qualifies:
- Diabetes mellitus
- Chronic heart failure
- End-Stage Renal Disease (ESRD) requiring dialysis
- Chronic lung disorders (COPD, asthma)
- Cardiovascular disorders
- HIV/AIDS
- Dementia
- Certain mental health conditions
- Other Medicare-approved chronic or disabling conditions
I-SNP: Institutional Special Needs Plans
For people living in institutions or requiring institutional-level care
I-SNP plans are tailored for beneficiaries who live in a nursing home, skilled nursing facility, or other institution, or who require an institutional equivalent level of care at home. These plans coordinate all of your medical and long-term care services, ensuring seamless management of your complex healthcare needs. I-SNPs work closely with facility staff and care teams to provide comprehensive, integrated care.
Who qualifies:
- Residents of skilled nursing facilities
- Residents of nursing homes or long-term care facilities
- People receiving care in intermediate care facilities
- People living at home but certified to need institutional-level care
- Residents of assisted living facilities (in some cases)
Benefits of Special Needs Plans
Personalized Care Plans
Every SNP member receives an individualized Model of Care — a comprehensive healthcare plan created by a multidisciplinary team based on your specific needs and conditions.
Tailored Drug Formularies
SNPs design their prescription drug formularies around the conditions they serve, ensuring that the medications most important to you are covered at favorable tier levels.
Care Coordination
A dedicated care coordinator helps manage your appointments, specialists, medications, and transitions between care settings, ensuring nothing falls through the cracks.
Lower Out-of-Pocket Costs
Many SNPs, especially D-SNPs, offer $0 or very low premiums, copays, and deductibles. Dual eligible members may have nearly all costs covered between Medicare and Medicaid.
Extra Benefits
Many SNPs include dental, vision, hearing, transportation to medical appointments, over-the-counter allowances, meal delivery after hospital stays, and in-home support services.
Specialized Provider Networks
SNP networks include doctors and specialists who have expertise in the conditions the plan covers, so you receive care from providers who understand your specific health needs.
Enrolling in a Special Needs Plan
Unlike standard Medicare Advantage plans, SNPs have special enrollment rules that provide more flexibility:
- Enroll any time of year: If you meet the eligibility criteria for a SNP, you can typically enroll during a Special Enrollment Period at any time — not just during the Annual Enrollment Period (October 15 - December 7).
- Must meet eligibility requirements: You must demonstrate that you qualify for the specific type of SNP. For D-SNPs, this means proving dual eligibility. For C-SNPs, you must have a qualifying chronic condition. For I-SNPs, you must reside in or qualify for institutional care.
- Verification process: The plan will verify your eligibility before or shortly after enrollment. For D-SNPs, this involves confirming your Medicaid status. For C-SNPs, your doctor may need to certify your qualifying condition.
- Continued eligibility: SNPs periodically re-verify that members still meet the plan's eligibility requirements. If your circumstances change (for example, you no longer qualify for Medicaid), you may have a grace period to find alternative coverage.
Is a Special Needs Plan Right for You?
A Special Needs Plan may provide better coverage and support than a standard Medicare Advantage plan if you fall into one of these categories:
- You have both Medicare and Medicaid and want a plan that coordinates both programs to minimize your out-of-pocket costs.
- You have a serious chronic condition like diabetes, heart failure, COPD, or ESRD and want a plan designed around managing that specific condition.
- You live in a nursing home, skilled nursing facility, or require institutional-level care at home.
- You want a dedicated care coordinator who understands your health challenges and helps manage all aspects of your care.
- You need extra benefits like transportation, in-home support, or meal delivery that are commonly offered by SNPs.
At MAC Insurance, our licensed agents will help determine if you qualify for a Special Needs Plan, compare available SNPs in your area, and guide you through the enrollment process.
Find Out If You Qualify for a Special Needs Plan
Special Needs Plans offer powerful benefits for those who qualify. Our licensed agents will review your eligibility, compare available plans, and help you enroll in the coverage that best fits your unique healthcare needs.