Medicare Advantage Special Needs Plans (SNP)s offer Medicare benefits through insurance companies for people who need targeted healthcare and care coordination.
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A Medicare Advantage SNP is one of the four types of Medicare Advantage Plans. Medicare Advantage Plans are also referred to as Medicare Part C, which includes coverage for Original Medicare Parts A and B. All Medicare Advantage SNPs also provide Part D prescription drug coverage.
All SNPs must cover the same benefits as Original Medicare Part A and Part B. How you pay for your portion of costs for services looks different.
Coverage for Part A and B includes:
SNPs also include services which are not covered by Medicare:
How the plan works
With a Medicare Advantage SNP, an insurance company manages your health care services through a select approved group of healthcare providers and medical facilities. This is called in-network care. Some SNPs cover services out-of-network and some don’t. Check with the plan to see if they cover services out of network, and if so, how it affects your costs. Medicare SNPs typically have specialists in the diseases or conditions that affect their members.
Medicare SNPs offer coverage tailored to meet the needs of Medicare beneficiaries with more complicated medical conditions. These plans are broken down into three types:
|Advantages of a Medicare Advantage SNP||Disadvantages of a Medicare Advantage SNP|
A Medicare Advantage SNP might be a good fit if you:
|Plan type||Costs||Part A coverage||Part B coverage||Part D coverage||Out-of-state care|
|Original Medicare||Part B premium||Yes||Yes||No||Yes|
|Medicare Advantage HMO||Part B premium plus plan premium||Yes||Yes||Usually||Emergency only|
|Medicare Advantage PPO||Part B premium plus plan premium||Yes||Yes||Usually||Emergency, plus other care if in your plan’s network, or you pay more for out of network|
|Medicare Advantage PFFS||Part B premium plus plan premium||Yes||Yes||Sometimes||Emergency, plus other care if contracted with your plan and agrees to treat you.|
|Medicare Advantage SNP||Part B premium||Yes||Yes||Yes||Emergency and out-of-area dialysis plus other care if in your plan’s network|
You must be enrolled in Medicare Parts A and B to apply for an SNP. You must also qualify for one of the three types of SNP options.
You can search for an available plan in your area on the Medicare website.
Expect to pay about $170 per month for your Part B premium for your Medicare Advantage SNP. Many SNPs have zero premiums, and if you are eligible for a D-SNP, Medicaid may pay for part of your premium and for most other out-of-pocket costs. You’ll have additional costs when you use your coverage if you have a C-SNP or I-SNP, including:
SNP providers are limited in what they can charge for covered services, so the individual items billed are typically within the amounts allowed by Medicare. Overall, the cost of an SNP should be close to what you would expect to pay for a Medicare Advantage plan.
Costs and availability of plans vary from state to state.
See how costs compare for these different types of SNP plans in Denver County, CO (plans include drug coverage):
|Plan name||Monthly premium||Deductible||Copay||Coinsurance||Out-of-pocket max|
|UnitedHealthcare Chronic Complete (HMO C-SNP)||$0||$0||PCP: $0
|0 – 20%||$3,900|
|UnitedHealthcare Dual Complete (HMO D-SNP)||$0||$0 (health)
|0%||$7,550 (but most out-of-pocket costs are covered by Medicaid)|
|Anthem Mediblue Care on Site (HMO I-SNP)||$0||$0||PCP: $0
|0 – 20%||$2,500|
To enroll in a Medicare Advantage Plan, you first need to be enrolled in Original Medicare Part A and Part B. After you’re enrolled in Original Medicare, you can enroll in an SNP any time as long as you meet eligibility requirements. If you no longer meet criteria, you will be able to switch to a different health plan.
If you’re interested in an SNP program, you can apply online or call Medicare at 1-800-633-4227 for more information. Check to see if there is an SNP available in your area. Each type of SNP plan has specific enrollment requirements.
Roseann Birch has worked in the insurance industry for more than 35 years. In 2006, she moved to selling insurance and, by 2009, Birch made Medicare her area of expertise after observing the struggles of older adults to understand Medicare. Although many adults age 65 and older are eligible for Medicare, nearly just as many don’t understand how it works.
Birch has learned the ins and outs of Medicare and its variations and supplements to help beneficiaries and their families understand benefits. She finds there is often misinformation and makes it her mission to clear up the confusion so that everyone can enjoy the full extent of Medicare benefits.