You might be familiar with special needs plans that are created for children in school, such as an Individualized Education Plan (IEP) or a 504 plan. But did you know there are special needs health plans, too? These plans help people with certain medical needs get the best kind of care for them. Learn more about what they are, who’s eligible, and how you can enroll.
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What Is A Special Needs Health Plan?
A special needs plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP). Medicare Advantage plans (also called Part C) provide Medicare Part A (hospital insurance) and Part B (medical insurance) coverage.
SNPs help people with special needs receive personalized care. In this situation, a “special needs individual” falls into one of three categories:
- Someone who is institutionalized (such as in a nursing home or other care facility)
- Someone who is dually eligible (more on this in a minute)
- Someone who has a severe or disabling chronic condition
SNPs have to meet high standards to prove they will meet the needs of people who enroll.
The Three Types of Special Needs Plans
There are three types of special needs plans: Chronic Condition SNP (C-SNP), Dual Eligible SNP (D-SNP), and Institutional SNP (I-SNP). Each of these SNPs follows Medicare Advantage rules and includes Part D prescription drug coverage.
1. Chronic Condition SNP (C-SNP)
To enroll in a Chronic Condition SNP, you must meet the following definition:
“…have one or more comorbid and medically complex chronic conditions that are substantially disabling or life threatening; have a high risk of hospitalization or other significant adverse health outcomes; and require specialized delivery systems across domains of care.”
In other words, you must have at least one lifelong health condition that significantly affects your life and requires special treatment. This could be something like chronic heart failure, cancer or bipolar disorder.
2. Dual Eligible SNP (D-SNP)
A Dual Eligible SNP is meant for people who are eligible for both Medicare and Medicaid.
Medicare is intended for people who are 65 years of age or older. But you might be eligible sooner if you have certain health conditions. And you may be entitled to Medicaid if you have a low income or need long-term services (every state has different requirements).
If you meet the eligibility requirements for both programs, you may be able to get a D-SNP. This plan might help you avoid duplicative costs.
3. Institutional SNP (I-SNP)
An Institutional SNP is meant for people who are eligible for Medicare Advantage and who need the following services for 90 days or longer:
- A long-term care skilled nursing facility
- A long-term care nursing facility
- A skilled nursing facility
- A nursing facility
- An intermediate care facility for individuals with intellectual disabilities
- An inpatient psychiatric facility
If you are a resident in one of these facilities, an I-SNP might work for you. Even if you’re only recovering from an illness before going home, you are still eligible for this type of plan as long as you’ll be at the facility for a minimum of 90 days.
How to Get A Special Needs Plan
If you are having trouble accessing the healthcare you need, consider whether a special needs plan might be right for you. You can enroll in a special needs plan by using Medicare’s search tool to find the best option.
Want more? You may be interested in reading Do You Qualify for a Service or Companion Animal? or Caring for an Adult Child with Disabilities blogs.
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