TABLE OF CONTENTS

What you should know:
  1. Medicare Advantage SNPs can provide comprehensive coverage and care coordination for everything from doctor’s visits, preventive care, and lab services to hospital stays and nursing facility care.
  2. SNPs can offer customized healthcare packages and easier access to care for certain groups, but not every plan is available in every area.
  3. With a Medicare Advantage SNP, private insurance companies manage your healthcare services through a select approved group of healthcare providers and medical facilities.
  4. Enrollment in Original Medicare Parts A and B is necessary, but you can enroll in an SNP at any time if you meet eligibility criteria.

What is a Medicare SNP Plan?

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.

What’s covered

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:

  • Inpatient care in a hospital or Skilled Nursing Facility (SNF)
  • Short-term SNF care after a qualifying hospital stay
  • Home health care
  • Hospice care (service is covered under the Part A Hospice Medicare Benefit)
  • Outpatient medically necessary services needed to treat or diagnose your medical condition
  • Preventive care
  • Durable medical equipment (DME)
  • Ambulance services
  • Clinical research
  • Mental health care
  • Specialists in disease and conditions which affect SNP group members

SNPs also include services which are not covered by Medicare:

  • Prescription drug coverage
  • Target services and care coordination
  • Vision, dental, and hearing care (you may pay an extra monthly premium for more comprehensive coverage)
  • Fitness club memberships

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:

  • Chronic Condition Special Needs (C-SNP): Must have a severe or disabling chronic condition
  • Institutional Special Needs (I-SNP): Must live in an institution, like a nursing home, or required skilled nursing care at home
  • Dual Eligible SNP (D-SNP): Must have Medicare and Medicaid.
Advantages of a Medicare Advantage SNP Disadvantages of a Medicare Advantage SNP
  • All options include drug coverage Medicare Part D.
  • More coverage than Medicare Part A and B for members
  • More affordable drug costs
  • Targeted services
  • Care coordination
  • Some plans include dental, hearing, and vision coverage
  • Can enroll at any time if you meet eligibility criteria
  • Not available in every area
  • You typically only have a small local or regional network of providers that can provide covered care.
  • You must choose a primary care provider (PCP) who oversees most of your medical care and provides referrals
  • Enrollment process is more complicated and requires medical documentation.

Who should get a Medicare Advantage SNP?

A Medicare Advantage SNP might be a good fit if you:

  • Meet eligibility criteria
  • Find a plan in your area with your preferred providers
  • Need institutionalization. SNPs provide more coverage
  • Have a chronic condition. SNPs offer targeted benefits and medication coverage
  • Have Medicare and Medicaid. SNPs provide care coordination and lowest possible costs.

Compare your Medicare options

See how a Medicare SNP compares to Original Medicare and other Medicare Advantage Plan types.
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

Who is eligible for a Medicare SNP?

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.

  • If you have a chronic health condition, such as congestive heart failure, addiction, dementia, diabetes, HIV/AIDS, end-stage renal disease or similar illnesses, C-SNP plans may be an option for you.
  • If you currently reside in a nursing home or other institutional setting and need to remain for longer than 90 days, you may qualify for an I-SNP.
  • If you are dually eligible for Medicaid andMedicare, you may qualify for a D-SNP.

You can search for an available plan in your area on the Medicare website.

How much does a Medicare SNP cost?

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:

  • Copays: You may need to pay copays if you visit the doctor or receive other medical services. The insurer sets this amount.
  • Coinsurance: You may pay a percentage of the Medicare-approved service charge after you have exhausted your deductible for the year.
  • Deductibles: You may have to pay an annual out-of-pocket amount before your insurance begins to pay for services.
  • Out-of-network charges: These may apply if you seek care from a medical provider outside your plan network.
  • Additional services: Some plans that offer vision, dental, and hearing coverage may charge higher premiums and a separate drug deductible.

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

Specialist: $25

 0 – 20% $3,900
UnitedHealthcare Dual Complete (HMO D-SNP) $0 $0 (health)

$480 (drug)

 PCP: $0

Specialist: $0

 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

Specialist: $0

 0 – 20% $2,500

How do I enroll in a Medicare SNP?

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.

  • C-SNP: When applying for C-SNP, you must include a note from your doctor stating your diagnosis, which must be on the list of covered conditions.
  • I-SNP: If you are interested in an I-SNP, you must have exceeded a 90-day stay in an approved long-term care facility, or have a medical necessity for a nursing home’s higher level of care.
  • D-SNP: Dual eligibility plans require documentation that you’ve been approved for Medicaid. A copy of an approval letter or insurance card is often enough.
author-img
Roseann Birch
Medicare consultant

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.

author-img
Roseann Birch
Medicare consultant

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.

Sources