Medicare Advantage SNPs

Special Needs Plans (SNPs) are Medicare Advantage plans that have specific member requirements. There are plans for people with certain chronic conditions, people who are dual-eligible for Medicare and Medicaid, and people who live in institutions. Each of these plan types is designed to care for the needs of its members. To learn more about SNPs in your area, speak with an agent of Avila Medicare Solutions.

Intro to SNPs

Special Needs Plans (SNPs) are built to cater to the needs of the members of their plan. There are three types of SNPs, and each is restricted to people who meet certain criteria.

Chronic Condition SNPs (C-SNPs) are for people who have one or more chronic conditions as defined by the Centers for Medicare and Medicaid Services (CMS). These SNPs are designed to help bring their members the healthcare they need. That includes access to treatment and coverage for their conditions and the ability to access a network of healthcare professionals who can treat their condition.

Dual Eligible SNPs (D-SNPs) are for people who are eligible for both Medicare and Medicaid. These SNPs give their members access to a network of healthcare providers who accept Medicaid coverage.

Institutional SNPs (I-SNPs) are for people who live in an institution like a skilled nursing facility or adult disability center on a permanent basis (at least 90 days). These plans provide their members with all of the coverage that this population needs.

SNP Coverage

As a type of Medicare Advantage plan, Special Needs Plans have all of the coverage you get under Medicare Part A and Part B. This includes hospital and medical insurance, covering inpatient care in a hospital or skilled nursing facility, hospice care, home health care, preventive care, and medically necessary services.

All SNPs also have prescription drug coverage.

SNP Costs

For your SNP, you will need to pay premiums, a yearly deductible, copayments, and coinsurance. Prescription drug costs will operate the same way as under a Part D plan. You will pay copayments based on whether or not your prescription is generic or brand-name, preferred or non-preferred, or a specialty drug. You will also need to continue paying your Part A and Part B monthly premiums, as with all Medicare Advantage plans.

Plan Comparison

Special Needs Plans require you to have a primary care doctor or a care coordinator. You must also get a referral to see a specialist in most cases.

These plans have networks of healthcare providers that cater to the needs of these groups. The ability of people with chronic conditions to visit specialists and healthcare providers who can treat their conditions is a critical benefit of C-SNPs. D-SNPs offer low prescription drug costs and special financing options, making sure your providers accept Medicaid coverage. The networks of SNPs are designed to be a benefit to plan members.

For more information about SNPs that you may qualify for or to learn about other Medicare Advantage plan types, speak with an agent of Avila Medicare Solutions.