With Medicare Advantage, beneficiaries use private insurance policies offered by Medicare. Medicare Advantage plans come in four forms: Health maintenance organizations (HMOs), preferrered provider organizations (PPOs), private fee-for-service (PFFS) programs, and special needs plans (SNPs). Medicare Advantage SNPs are specialized for those with chronic conditions. Read on to learn more about SNPs and whether they may be right for you.
SNPs are part of Medicare Advantage.
Special needs plans are Medicare Advantage plans tailored for specific medical concerns.
“These plans can be specifically tailored to the type of ongoing treatments and medications needed by these individuals and can be a good balance of maintaining necessary health coverage while keeping fees manageable,” Erin Nance, MD, a New York City-based orthopedic surgeon, tells WebMD Connect to Care.
SNPs limit enrollment and benefits around specific concerns or chronic condition.
A SNP provides a specific list of available providers and services, depending on the Medicare beneficiary's condition. For example, if you have an autoimmune disorder or a mental health condition, your SNP could cover services like home health care or behavioral health services. Some SNPs also provide care coordinators or counselors who can monitor your health.
With SNPs, “there are established networks of doctors who specialize in [a particular] chronic disease,” Nance says. “Patients with end-stage renal disease requiring dialysis are examples of patients who would ideally fit into the Special Needs plan.”
SNPs are required to provide Part D drug coverage.
“The advantage to the Special Needs plan, if you meet the criteria, is that it typically includes the same benefits as a Medicare Part D prescription drug plan, which can help defray the costs of ongoing prescription medication,” Nance says.
In fact, according to the Centers for Medicare and Medicaid Services (CMS), SNPs are required to provide Part D benefits “because special needs individuals must have access to prescription drugs to manage and control their special health care needs.”
If you need long-term nursing care, you might qualify for a SNP.
If you’re planning to receive long-term nursing care, whether at home or in a facility, you may qualify for an SNP. You also qualify if you receive both Medicare and Medicaid services or if you have any chronic conditions, including chronic heart disease or diabetes, that require long-term care. According to The Official U.S. Government Site for Medicare online, some examples of SNP-qualifying conditions are:
- Autoimmune disorders
- Cardiovascular disorders
- Neurologic disorders
- Cancer (excluding pre-cancer conditions)
- Chronic lung disorders
- Chronic alcohol and other dependence
- Diabetes mellitus
- Chronic and disabling mental health conditions
- Severe hematologic disorders
- Chronic heart failure
- End-stage liver disease
- End-Stage Renal Disease (ESRD) requiring dialysis (any mode of dialysis)
Here’s how to apply for an SNP.
If you think you qualify for an SNP, you first need to get a note from your doctor detailing your condition. Then, you have to find out if there are SNPs available in your area. An easy way to get started is to contact your local SHIP, or state health insurance assistance program, where you can get free health care counseling and advice. Your counselor can help you find a Medicare Advantage plan that’s right for you.