What is a Medicare Advantage special needs plan?

Medicare Advantage special needs plans (SNPs) provide specialized coverage — extra benefits and coordinated care — for people who have chronic medical conditions or face certain situations.

The Medicare Modernization Act of 2003 established SNPs, but they weren’t offered until 2006. Today, all these plans provide medical and prescription drug coverage, and many have dental, hearing and vision benefits. In 2023, 19 percent of all Medicare Advantage enrollees are in special needs plans.

Special needs plans come in three types, each with its own eligibility requirements and coverage.

• Chronic condition special needs plans (C-SNPs) offer specialized coverage for people with some chronic conditions, such as diabetes and end-stage renal disease.

• Dual eligible special needs plans (D-SNPs) create coordinated coverage for people eligible for both Medicare and Medicaid.

• Institutional special needs plans (I-SNPs) are for people who live in an institution, such as a nursing home, or who require institutional-level nursing care at home.

In 2023, the number of special needs plans in the United States grew to 1,335, a 12 percent increase from 2022 and more than double what was offered in 2018. In 2023, more than 5.7 million Medicare beneficiaries are enrolled in Medicare Advantage SNPs, a 24 percent increase from 2022, according to KFF, formerly the Kaiser Family Foundation.    

What is a chronic condition special needs plan?

Chronic condition special needs plans offer coverage for people with cardiovascular disease, diabetes, end-stage renal disease, respiratory disease and several other chronic conditions. While less common, some C-SNPs cover conditions such as chronic mental illnesses, dementia and HIV/AIDS.

The plans provide benefits tailored to people with long-term conditions. Benefits could include provider networks with specialists in your condition and access to special drug coverage to treat your condition.

A C-SNP for people with end-stage renal disease might include:

• 24/7 access to a dedicated kidney care team.

• Coverage for medications specific to kidney conditions.

• Reduced cost sharing for services and supplies for dialysis.

Additionally, some plans offer advisers who monitor your care and medicine. If you have diabetes, a care coordinator may track your blood sugar; make sure you follow your diet, get proper exercise and have the right prescriptions to prevent complications; and schedule preventive services such as eye and foot exams.

Many of these plans also provide nonmedical benefits only available to people with chronic conditions, such as a prepaid flex card with a grocery allowance as well as meal, pest control and transportation benefits.

Nearly a quarter of Medicare Advantage SNPs are chronic condition plans, according to the Commonwealth Fund.

What is a dual eligible special needs plan?

Dual eligible special needs plans contract with state Medicaid programs to help coordinate benefits for people who simultaneously qualify for Medicare and Medicaid. It’s the most common type of special needs plan, accounting for 61.6 percent of SNPs in 2023.

A D-SNP may arrange for:

• A flex card with a grocery allowance and funds to cover over-the-counter medications and transportation.

• Medicaid to pay Part B premiums and cost sharing for Medicare services.

• No copayments for medications.

These plans offer care coordinators to help you with your Medicare and Medicaid benefits. D-SNPs have a network of providers who deal with Medicare and Medicaid. The care coordinators can also guide you to local community resources.