Medicare Special Needs Plans

A Special Needs Plan (SNP) is a type of Medicare Advantage insurance plan aimed at meeting the unique care of people with certain diseases or characteristics. SNPs can play an important role in special needs planning for people with disabilities or chronic ailments.

Rachel Christian, writer and researcher for RetireGuide
  • Written by
    Rachel Christian

    Rachel Christian

    Financial Writer and Certified Educator in Personal Finance

    Rachel Christian is a writer and researcher for RetireGuide. She covers annuities, Medicare, life insurance and other important retirement topics. Rachel is a member of the Association for Financial Counseling & Planning Education.

    Read More
  • Edited By
    Matt Mauney
    Matt Mauney, Senior Editor for RetireGuide

    Matt Mauney

    Financial Editor

    Matt Mauney is an award-winning journalist, editor, writer and content strategist with more than 15 years of professional experience working for nationally recognized newspapers and digital brands. He has contributed content for ChicagoTribune.com, LATimes.com, The Hill and the American Cancer Society, and he was part of the Orlando Sentinel digital staff that was named a Pulitzer Prize finalist in 2017.

    Read More
  • Published: June 17, 2020
  • Updated: September 20, 2022
  • 4 min read time
  • This page features 5 Cited Research Articles
Fact Checked
Fact Checked

Our fact-checking process starts with vetting all sources to ensure they are authoritative and relevant. Then we verify the facts with original reports published by those sources, or we confirm the facts with qualified experts. For full transparency, we clearly identify our sources in a list at the bottom of each page.

Cite Us
How to Cite RetireGuide.com's Article

APA Christian, R. (2022, September 20). Medicare Special Needs Plans. RetireGuide.com. Retrieved September 29, 2022, from https://www.retireguide.com/medicare/medicare-advantage-plans/coordinated-care-plans/snp/

MLA Christian, Rachel. "Medicare Special Needs Plans." RetireGuide.com, 20 Sep 2022, https://www.retireguide.com/medicare/medicare-advantage-plans/coordinated-care-plans/snp/.

Chicago Christian, Rachel. "Medicare Special Needs Plans." RetireGuide.com. Last modified September 20, 2022. https://www.retireguide.com/medicare/medicare-advantage-plans/coordinated-care-plans/snp/.

Why Trust RetireGuide.com
Why You Can Trust Us

Content created by RetireGuide and sponsored by our partners.

Key Principles

RetireGuide’s mission is to provide seniors with resources that will help them reach important financial decisions that affect their retirement. Our goal is to arm our readers with knowledge that will lead to a healthy and financially sound retirement.

We’re dedicated to providing thoroughly researched Medicare information that guides you toward making the best possible health decisions for you and your family.

RetireGuide LLC has partnerships with Senior Market Sales (SMS) and GoHealth.

Our partners are able to be reached through the phone numbers and/or forms provided on our website.

The content and tools created by RetireGuide adhere to strict Medicare and editorial guidelines to ensure quality and transparency.

Editorial Independence

While the experts from our partners are available to help you navigate various Medicare plans, RetireGuide retains complete editorial control over the information it publishes.

We operate independently from our partners, which allows the award-winning RetireGuide team to provide you with unbiased information.

Visitors can trust our inflexibility regarding our editorial autonomy. We do not allow our partnership to influence RetireGuide’s editorial content whatsoever.

What Is a Special Needs Plan?

A Special Needs Plan (SNP) is a type of Medicare Advantage coordinated care plan.

SNPs tailor the benefits, provider choices and drug formularies they offer to best serve the specific needs of beneficiaries.

For example, a private health insurance company might offer a SNP for people with heart disease. The plan benefits could include additional coverage for common medications used to treat heart disease as well as a network of doctors who specialize in cardiovascular health.

Like any Medicare Advantage plan, SNPs are required to provide the same basic benefits, rights and coverage as Original Medicare. But these plans may operate under different rules, network restrictions and costs.

All SNPs must provide Medicare prescription drug coverage. Some plans may offer additional benefits, such as vision, dental and hearing care.

Typically, you are required to seek care and services from providers within your SNP network. In most cases, SNPs require you to have a primary care doctor.

Different special needs plans are available depending on where you live. They are not available everywhere in the U.S.

A new Medicare beneficiary can join a SNP any time during the initial enrollment period.

Once enrolled, you can switch plans only between Oct. 15 and Dec. 7 each year, though a few exceptions to this rule exist.

Tip
You can use the Medicare Plan Finder to locate Special Needs Plans in your area.
Source: U.S. Centers for Medicare & Medicaid Services
Connect With a Medicare Advantage Professional
New updates are made every year to Medicare Advantage plans. Find out which plan is right for you.

Who Qualifies for Medicare Special Needs Plans?

Enrollment in a Medicare Advantage SNP is limited to specific groups.

This can include people living in institutions, people who are dual eligible for Medicare and Medicaid, or people with certain chronic conditions.

To qualify for a Medicare Advantage SNP, you must:
  • Be eligible for Medicare Parts A and B.
  • Be over 65 years old or have a disability and collect Social Security disability insurance.
  • Have a chronic condition, be eligible for Medicaid and Medicare, or need care at an institution, such as a nursing home.

You can only remain enrolled in a SNP if you meet the plan’s eligibility requirements.

Three Types of Special Needs Plans
Chronic Condition SNP (C-SNP)
For people with specific chronic conditions, such as cancer, dementia, diabetes, HIV, stroke and certain neurologic disorders.
Institutional SNP (I-SNP)
For people living in an institution, such as a nursing home, long-term care facility, assisted living facility or intermediate care facility for people with intellectual disabilities. To qualify, you must be in an institution for at least 90 days or expect to need institutional care for at least 90 days.
Dual Eligible SNP (D-SNP)
Low-income people over 65 and low-income people with severe disabilities can be eligible for Medicaid and Medicare at the same time. Dual eligible special needs plans serve beneficiaries who are dual enrolled in Medicare and Medicaid.

Chronic Condition SNPs

According to the U.S. Centers for Medicare & Medicaid Services, there are 15 conditions that qualify for a Chronic Condition Special Needs Plan, or C-SNP.

Eligible conditions for a C-SNP include:
  • Autoimmune disorders
  • Cancer (excluding pre-cancer conditions)
  • Cardiovascular disorders
  • Chronic alcohol and other dependence
  • Chronic heart failure
  • Chronic lung disorders
  • Chronic and disabling mental health conditions
  • Dementia
  • Diabetes mellitus
  • End-stage liver disease
  • End-Stage Renal Disease (ESRD) requiring dialysis
  • HIV/AIDS
  • Neurologic disorders
  • Severe hematologic disorders
  • Stroke

Costs of Special Needs Plans

If you have Medicaid, you will not pay Medicare deductibles and copays from providers in your Dual Eligible SNP network.

If you don’t have Medicaid, your exact costs will vary depending on the plan you select.

SNPs may include the following costs:
  • Medicare Part B premium
  • Monthly premium for your Special Needs Plan
  • Potential copayments, coinsurance or deductibles

Frequently Asked Questions About Special Needs Plans

Are prescription drugs covered?
Yes. All SNPs must provide Medicare prescription drug coverage.
Do I need a referral to see a specialist?
In most cases, you are required to get a referral to see a specialist.
What is a care coordinator in a SNP?
A care coordinator is a person who helps the beneficiary find appropriate services in his or her community. They help make sure people get the right care and information.
Last Modified: September 20, 2022

5 Cited Research Articles

  1. U.S. Centers for Medicare & Medicaid Services. (2022). Special Needs Plans (SNP). Retrieved from https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/special-needs-plans-snp
  2. U.S. Centers for Medicare & Medicaid Services. (2022). How Medicare Special Needs Plans (SNPs) Work. Retrieved from https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/how-medicare-special-needs-plans-snps-work
  3. U.S. Centers for Medicare & Medicaid Services. (2021, December 1). Chronic Condition Special Needs Plans (C-SNPs). Retrieved from https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans/C-SNPs
  4. Office of the Assistant Secretary for Planning and Evaluation. (2019, April 8). Integrating Care Through Dual Eligible Special Needs Plans (D-SNPS): Opportunities and Challenges. Retrieved from https://aspe.hhs.gov/reports/integrating-care-through-dual-eligible-special-needs-plans-d-snps-opportunities-challenges-0
  5. U.S. Centers for Medicare & Medicaid Services. (n.d.). What is a Special Needs Plan? Retrieved from https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans