How to Make Them Work for You

Medicare enrollees have access to Special Needs Plans (SNPs) designed for a variety of special situations. If you have a chronic condition, need institutional care or qualify for both Medicare and Medicaid, you may be able to enroll in an SNP.

SNP Basics

SNPs are a type of Medicare Advantage plan offered by private insurers. Like all Medicare Advantage plans, SNPs are required to provide certain benefits. Additionally, all SNPs provide Medicare prescription drug coverage, and SNPs may offer extra benefits, as well.

Some SNPs provide members with a care coordinator. The care coordinator assists beneficiaries to make sure they have the information and care that they need.

SNP Eligibility

SNP enrollment is limited. In order to enroll in an SNP, you must meet the plan’s eligibility requirements. There are three different types of SNPs with different enrollment requirements.

  • Dual-Eligible SNPs are designed for people who are eligible for both Medicare and Medicaid. Enrolling in a Dual-Eligible SNP can simplify coverage and cost issues for members.
  • Institutional SNPs are designed for Medicare beneficiaries who require institutional care. For example, if a Medicare beneficiary is in a nursing home or requires nursing care at home, enrollment in an Institutional SNP may be possible.
  • Chronic Condition SNPs are designed for Medicare enrollees who have been diagnosed with certain chronic conditions. For example, one Chronic Condition SNP might serve people with diabetes. Another Chronic Condition SNP might serve people with neurologic disorders. These plans may provide additional benefits to help members manage their chronic conditions.

Enrolling in an SNP

If you think you might qualify for an SNP, you should see which plans are available in your area. For example, if you have recently been diagnosed with a chronic condition, see whether there is a Chronic Condition SNP that caters to that condition where you live.

If you qualify for an SNP in your area, you will have a special enrollment period that lets you enroll. This means that you will not have to wait until the next open enrollment period to switch your plan. Additionally, if you qualify for Medicare and Medicaid, you will have three periods each year during which you can make a change to your coverage. These periods are January to March, April to June and July to September. You can only make one coverage change per period.

If your situation changes and you no longer qualify for your SNP, you will need to leave the plan and enroll in a different plan. You will have a special enrollment period to do this. Plans must give you a grace period of at least one month after your situation changes, and some plans may provide longer grace periods.

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