MEDICARE SPECIAL NEEDS PROGRAM

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What benefits and services are covered in Medicare SNPs?

 

Medicare SNPs cover the same Medicare services that all Medicare Advantage plans must cover. Medicare SNPs may also cover extra services tailored to the special groups they serve, like extra days in the hospital. Contact your plan to learn exactly what benefits and services the plan covers.

Medicare Special Need 

 

Special Needs Program

Eligibility

You can join a Medicare SNP if you meet these requirements:

  • You have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) .

  • You live in the plan's service area .

  • You meet the plan's eligibility requirements, like one of these:

  • Chronic Condition SNP (C-SNP): You have one or more of these severe or disabling chronic conditions:

  • Chronic alcohol and other dependence

  • Autoimmune disorders

  • Cancer (excluding pre-cancer conditions)

  • Cardiovascular disorders

  • Chronic heart failure

  • Dementia

  • Diabetes mellitus

  • End-stage liver disease

  • End-Stage Renal Disease (ESRD) requiring dialysis (any mode of dialysis)

  • Severe hematologic disorders

  • HIV/AIDS

  • Chronic lung disorders

  • Chronic and disabling mental health conditions

  • Neurologic disorders

  • Stroke

  • Institutional SNP (I-SNP): You live in an institution (like a nursing home), or you require nursing care at home.

  • Dual Eligible SNP (D-SNP): You have both Medicare and Medicaid .

 

Each Medicare SNP limits its membership to people in one of these groups, or a subset of one of these groups.

For example, a Medicare SNP may be designed to serve only people diagnosed with congestive heart failure. The plan might include access to a network of providers who specialize in treating congestive heart failure. It would also feature clinical case management programs designed to serve the special needs of people with this condition. The plan's drug formulary would be designed to cover the drugs usually used to treat congestive heart failure. People who join this plan would get benefits specially tailored to their condition, and have all their care coordinated through the Medicare SNP.

*Medicare Special Need 

Where are Medicare SNPs offered?

Each year, different types of Medicare SNPs may be available in different parts of the country. Insurance companies decide where they’ll do business, so Medicare SNPs may not be available in all parts of the country.

Insurance companies can decide that a plan will be available to everyone with Medicare in a state, or only in certain counties. Insurance companies may also offer more than one plan in an area, with different benefits and costs. Each year, insurance companies offering Medicare SNPs can decide to join or leave Medicare.

*Medicare Special Need