Special Needs Plans (SNPs) are a subset of Medicare Advantage plans available to people with special needs. These plans aren’t available in all areas. SNP plans help people with chronic disabilities or special needs.

What is a Medicare Special Needs Plan?

There are three categories of Special Needs Plans, C-SNP, D-SNP, and I-SNP.

How Medicare Advantage Special Needs Plans Works

What is a Chronic Special Needs Plan?

Chronic Special Needs Plans (C-SNP) are for Medicare Beneficiaries with severe and disabling chronic medical conditions. The conditions that qualify are considered medically complex, life-threatening, or substantially disabling.

Conditions that apply have a high risk of hospitalizations, significant adverse reactions, or specialized treatment delivery systems. Some of the most common conditions that apply are Chronic Obstructive Pulmonary Disease (COPD), Diabetes, Atrial Fibrillation (AFIB).

C-SNP plans make prescriptions and treatments less expensive related to the qualifying condition.

Upon enrolling, you must have your health care provider fill out a form verifying your chronic needs condition.

What is a Dual Eligible Special Needs Plan?

Dual Eligible Special Needs Plans (D-SNP) are designated to assist low-income beneficiaries. Qualifications vary from plan to plan.

To enroll in a D-SNP program, you must have Medicare and medical assistance from the state through the Medicaid system. Some states cover the costs of Medicare for the beneficiary.

D-SNPs have two options depending on the level of assistance the beneficiary is receiving.

  1. Medicare Zero-dollar cost-sharing plan.
  2. Medicare Non-Zero-cost sharing plan.

Qualifying and enrolling into a zero-dollar cost-sharing D-SNP plan means the beneficiary will have a $0 cost-share when receiving covered services.

Qualifying for a non-zero dollar cost-sharing plan means the beneficiary may have cost-sharing depending on the service and level of assistance.

What is an Institutional Special Needs Plan?

Institutional Special Needs Plans (I-SNP) are designated to assist beneficiaries considered institutionalized.

For 90 days or longer, the beneficiary must have had or expect to need the level of care provided from one of the following:

  • Skilled Nursing Facility (SNF)
  • Long Term Care (LTC)
  • LTC Nursing facility (NF)
  • Intermediate care facility for people with intellectual disabilities (ICF/IDD)
  • Inpatient Psychiatric Facility to qualify for an I-SNP

Medicare beneficiaries living in the community can qualify if the following conditions apply:

  • A determination of institutional LOC must be determined using the states assessment tool. The assessment must be the same determination used for beneficiaries living in an institution.
  • An independent, impartial party with the professional knowledge to identify and assess the institutional needs must administer the assessment.

How do I Appeal an SNP Disenrollment Notice?

The beneficiary has the right to appeal if they disagree with the notice. An independent agency will look over the appeal forms.

If discharged from the hospital early due to disenrollment, you have the right to an immediate review. The review is conducted by the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO).

The hospital is then required to allow you to stay at no cost. The hospital can’t discharge the beneficiary until after the review is complete.

Beneficiaries under the care of a skilled nursing facility, comprehensive rehabilitation center, or home health care have the fast-track right to appeal.

If you plan to file an appeal, you should have a few things handy before starting the process. Ask your doctor(s) for any documentation or information that’ll assist in proving your case.

If your health status concern you, ask for a fast appeal. Within 72 hours, you should have an answer.

How to Enroll in a Medicare Advantage Special Needs Plan

Of course, there is. We would love to be your advocate. Call one of our licensed representatives, or fill out our online request form. We would be happy to review your situation and help you determine which plan fits your needs.

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by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.