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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.

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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, diabetesend-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.

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What is an institutional special needs plan?

Institutional special needs plans provide care coordination and sometimes oversight to avoid complications for Medicare beneficiaries who are expected to live for at least 90 days in a nursing home, skilled nursing facility or other institutional setting. I-SNPs often cover people who live in the community but need institutional-level care in their homes, such as a nurse practitioner who:

  • Coordinates care between your primary care provider and a facility’s care team.
  • Visits you in a nursing home to monitor your care.

While they’re the least common among SNPs, I-SNPs have been significantly increasing, from 97 plans in 2018 to 192 plans in 2023.

How do I find a special needs plan?

Medicare Advantage SNPs are available only in certain areas. You must be enrolled in Medicare Part A and Part B and live in a plan’s service area, similar to Medicare Advantage, to sign up. Even if you qualify to participate in an SNP, one might not be available where you live.

To find an SNP and compare other types of Medicare Advantage plans, consult the Medicare Plan Finder. In the list of plans, click on the type of special needs plan in the filter by section.

Keep in mind

It’s a good idea to research coverage and costs for plans other than SNPs in your area before choosing a plan. Your State Health Insurance Assistance Program can also help you.

Before you enroll in a special needs plan, think about whether you want your health and drug coverage from a Medicare Advantage plan or from original Medicare.

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